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_cond_oth1	pbp_a_snp_cond_oth2	pbp_a_snp_cond_oth3	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
E3014	801	0		30	13	E3014_801_0	2	1						06/06/2022	2023.01	06/06/2022 10:16:53 AM Eastern Daylight Time					06/06/2022 10:18:14 AM 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	2023	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	2	1						06/06/2022	2023.01	06/06/2022 10:17:30 AM Eastern Daylight Time					06/06/2022 10:18:14 AM 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	2023	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																
H0022	001	0	1	48	05	H0022_001_0	3	1						07/14/2022	2023.01	07/14/2022 06:52:26 AM Eastern Daylight Time					07/14/2022 08:40:12 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	2023	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	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:23:02 PM Eastern Daylight Time	08/03/2022 03:43:17 PM Eastern Daylight Time	07/30/2022 05:00:28 AM Eastern Daylight Time			08/04/2022 11:32:49 AM 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	2023	Omaha		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:01:45 PM Eastern Daylight Time	08/03/2022 03:41:14 PM Eastern Daylight Time	07/30/2022 05:00:54 AM Eastern Daylight Time			08/04/2022 11:32:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-014 (HMO)	01	01		1			H0028	014	0	2023	St. Louis Metro area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H0028_015_0	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:21:53 PM Eastern Daylight Time	08/03/2022 03:39:17 PM Eastern Daylight Time	07/30/2022 05:01:20 AM Eastern Daylight Time			08/04/2022 11:32:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP)	01	02		1			H0028	015	0	2023	Select Counties in Missouri		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H0028_016_0	3	1			1		1	05/31/2022	2023.01	05/31/2022 02:20:48 PM Eastern Daylight Time	08/03/2022 03:42:16 PM Eastern Daylight Time	07/30/2022 05:01:44 AM Eastern Daylight Time			08/04/2022 11:32:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-016 (HMO-POS)	01	02		1			H0028	016	0	2023	Springfield/Joplin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:01:58 PM Eastern Daylight Time	08/03/2022 03:41:46 PM Eastern Daylight Time	07/30/2022 05:02:08 AM Eastern Daylight Time			08/04/2022 11:32:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-017 (HMO)	01	01		1			H0028	017	0	2023	Kansas City		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:23:20 PM Eastern Daylight Time	08/03/2022 03:50:52 PM Eastern Daylight Time	07/30/2022 05:02:34 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-019 (HMO)	01	01		1			H0028	019	0	2023	Albuquerque Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	021	0	1	01	01	H0028_021_0	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:16:55 PM Eastern Daylight Time	08/03/2022 03:52:00 PM Eastern Daylight Time	07/30/2022 05:02:58 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-021 (HMO)	01	01		1			H0028	021	0	2023	Pima and Pinal Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 10:41:04 AM Eastern Daylight Time	08/03/2022 03:53:08 PM Eastern Daylight Time	07/30/2022 05:03:24 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-023 (HMO)	01	01		1			H0028	023	0	2023	Yavapai, La Paz, Mohave, and Maricopa Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:23:56 PM Eastern Daylight Time	08/03/2022 03:54:15 PM Eastern Daylight Time	07/30/2022 05:03:48 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-024 (HMO)	01	01		1			H0028	024	0	2023	La Paz and Mohave counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:17:36 PM Eastern Daylight Time	08/03/2022 03:59:55 PM Eastern Daylight Time	07/30/2022 05:04:14 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-025 (HMO)	01	01		1			H0028	025	1	2023	Colorado	Denver Metro Area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	01	01	H0028_025_2	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:18:15 PM Eastern Daylight Time	08/03/2022 04:01:01 PM Eastern Daylight Time	07/30/2022 05:04:40 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-025 (HMO)	01	01		1			H0028	025	2	2023	Colorado	North and South Colorado Area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	027	0	1	01	01	H0028_027_0	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:18:50 PM Eastern Daylight Time	08/03/2022 03:55:19 PM Eastern Daylight Time	07/30/2022 05:05:04 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-027 (HMO)	01	01		1			H0028	027	0	2023	Maricopa County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:37:25 PM Eastern Daylight Time	08/03/2022 03:58:47 PM Eastern Daylight Time	07/30/2022 05:05:28 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-028 (HMO)	01	01		1			H0028	028	0	2023	Maricopa and Yavapai Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/03/2022	2023.01	08/03/2022 03:08:49 PM Eastern Daylight Time	08/03/2022 03:42:28 PM Eastern Daylight Time	07/30/2022 05:05:54 AM Eastern Daylight Time			08/04/2022 12:38:17 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-029 (HMO)	01	01		1			H0028	029	0	2023	Corpus Christi Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:50:42 PM Eastern Daylight Time	08/03/2022 03:42:54 PM Eastern Daylight Time	07/30/2022 05:06:18 AM Eastern Daylight Time			08/04/2022 12:38:17 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-030 (HMO)	01	01		1			H0028	030	0	2023	San Antonio Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 06:04:25 PM Eastern Daylight Time	08/03/2022 03:43:20 PM Eastern Daylight Time	07/30/2022 05:06:42 AM Eastern Daylight Time			08/04/2022 12:38:17 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	2023	Select Counties in Texas		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:51:43 PM Eastern Daylight Time	08/03/2022 03:47:37 PM Eastern Daylight Time	07/30/2022 05:07:06 AM Eastern Daylight Time			08/04/2022 12:38:17 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	2023	Select Counties in Texas		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:52:08 PM Eastern Daylight Time	08/03/2022 03:48:02 PM Eastern Daylight Time	07/30/2022 05:07:32 AM Eastern Daylight Time			08/04/2022 12:38:17 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	2023	Fort Bend, Harris and Montgomery counties		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:52:59 PM Eastern Daylight Time	08/03/2022 03:48:27 PM Eastern Daylight Time	07/30/2022 05:07:56 AM Eastern Daylight Time			08/04/2022 12:38:17 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	2023	El Paso County		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:53:28 PM Eastern Daylight Time	08/03/2022 03:43:45 PM Eastern Daylight Time	07/30/2022 05:08:20 AM Eastern Daylight Time			08/04/2022 12:38:17 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-035 (HMO)	01	01		1			H0028	035	0	2023	El Paso County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	07/07/2022	2023.01	07/07/2022 11:00:20 AM Eastern Daylight Time	08/03/2022 03:44:11 PM Eastern Daylight Time	07/30/2022 05:08:46 AM Eastern Daylight Time			08/04/2022 01:54:05 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	2023	Corpus Christi/San Antonio area		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:53:54 PM Eastern Daylight Time	08/03/2022 03:44:39 PM Eastern Daylight Time	07/30/2022 05:09:10 AM Eastern Daylight Time			08/04/2022 12:38:17 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-037 (HMO)	01	01		1			H0028	037	0	2023	Bastrop, Hays, Travis and Williamson counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 03:54:30 PM Eastern Daylight Time	08/03/2022 03:45:04 PM Eastern Daylight Time	07/30/2022 05:09:34 AM Eastern Daylight Time			08/04/2022 12:38:17 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	2023	Corpus Christi Metro Area		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:54:54 PM Eastern Daylight Time	08/03/2022 03:45:30 PM Eastern Daylight Time	07/30/2022 05:09:58 AM Eastern Daylight Time			08/04/2022 12:38:17 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-041 (HMO)	01	01		1			H0028	041	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:03:47 PM Eastern Daylight Time	08/03/2022 03:45:55 PM Eastern Daylight Time	07/30/2022 05:10:22 AM Eastern Daylight Time			08/04/2022 01:09:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-042 (HMO)	01	01		1			H0028	042	0	2023	Houston Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:04:21 PM Eastern Daylight Time	08/03/2022 03:46:21 PM Eastern Daylight Time	07/30/2022 05:10:46 AM Eastern Daylight Time			08/04/2022 01:09:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-043 (HMO)	01	01		1			H0028	043	1	2023	Dallas area	Dallas area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:04:48 PM Eastern Daylight Time	08/03/2022 03:46:46 PM Eastern Daylight Time	07/30/2022 05:11:10 AM Eastern Daylight Time			08/04/2022 01:09:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-043 (HMO)	01	01		1			H0028	043	2	2023	Dallas area	Dallas area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 04:05:17 PM Eastern Daylight Time	08/03/2022 03:48:52 PM Eastern Daylight Time	07/30/2022 05:11:34 AM Eastern Daylight Time			08/04/2022 01:09:42 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	2023	Bastrop, Hays, Travis and Williamson counties		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:05:48 PM Eastern Daylight Time	08/03/2022 03:49:17 PM Eastern Daylight Time	07/30/2022 05:11:58 AM Eastern Daylight Time			08/04/2022 01:09:42 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	2023	Cameron, Hidalgo and Willacy counties		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:06:29 PM Eastern Daylight Time	08/03/2022 03:49:42 PM Eastern Daylight Time	07/30/2022 05:12:22 AM Eastern Daylight Time			08/04/2022 01:09:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-046 (HMO)	01	01		1			H0028	046	0	2023	Cameron, Hidalgo and Willacy counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/29/2022	2023.01	05/29/2022 01:12:49 PM Eastern Daylight Time	08/03/2022 04:04:31 PM Eastern Daylight Time	07/30/2022 05:12:46 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-047 (HMO)	01	01		1			H0028	047	0	2023	Colorado		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1	1	01	01	H0028_048_1	3	1			1		1	08/01/2022	2023.01	08/01/2022 08:17:37 AM Eastern Daylight Time	08/03/2022 04:16:44 PM Eastern Daylight Time	07/30/2022 05:13:12 AM Eastern Daylight Time			08/04/2022 01:07:51 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-048 (HMO)	01	01		1			H0028	048	1	2023	Honolulu, Kauai and Maui counties	Honolulu County	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 08:18:56 AM Eastern Daylight Time	08/03/2022 04:17:15 PM Eastern Daylight Time	07/30/2022 05:13:48 AM Eastern Daylight Time			08/04/2022 01:07:51 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-048 (HMO)	01	01		1			H0028	048	2	2023	Honolulu, Kauai and Maui counties	Kauai and Maui counties	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 01:06:04 PM Eastern Daylight Time	08/03/2022 04:05:34 PM Eastern Daylight Time	07/30/2022 05:14:12 AM Eastern Daylight Time			08/04/2022 11:32:49 AM 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	2023	Select Counties in Kansas and Missouri		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 01:06:19 PM Eastern Daylight Time	08/03/2022 04:05:02 PM Eastern Daylight Time	07/30/2022 05:14:38 AM Eastern Daylight Time			08/04/2022 11:32:49 AM 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	2023	Select Counties in Missouri		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:19:30 PM Eastern Daylight Time	08/03/2022 04:13:41 PM Eastern Daylight Time	07/30/2022 05:15:02 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-052 (HMO)	01	01		1			H0028	052	0	2023	Maricopa Pima Pinal		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:06:33 PM Eastern Daylight Time	08/03/2022 04:06:38 PM Eastern Daylight Time	07/30/2022 05:15:26 AM Eastern Daylight Time			08/04/2022 11:32:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-053 (HMO)	01	01		1			H0028	053	1	2023	Iowa, Nebraska, South Dakota	Iowa	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:06:48 PM Eastern Daylight Time	08/03/2022 04:07:39 PM Eastern Daylight Time	07/30/2022 05:15:52 AM Eastern Daylight Time			08/04/2022 11:32:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-053 (HMO)	01	01		1			H0028	053	2	2023	Iowa, Nebraska, South Dakota	Iowa	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:07:02 PM Eastern Daylight Time	08/03/2022 04:07:10 PM Eastern Daylight Time	07/30/2022 05:16:16 AM Eastern Daylight Time			08/04/2022 11:40:13 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-053 (HMO)	01	01		1			H0028	053	3	2023	Iowa, Nebraska, South Dakota	Eastern Nebraska	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 10:05:47 AM Eastern Daylight Time	08/03/2022 04:21:40 PM Eastern Daylight Time	07/30/2022 05:16:42 AM Eastern Daylight Time			08/04/2022 11:40:13 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-053 (HMO)	01	01		1			H0028	053	4	2023	Iowa, Nebraska, South Dakota	South Dakota	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	054	1	1	02	01	H0028_054_1	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:35:36 PM Eastern Daylight Time	08/03/2022 04:14:44 PM Eastern Daylight Time	07/30/2022 05:17:06 AM Eastern Daylight Time			08/04/2022 10:43:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-054 (HMO-POS)	01	02		1			H0028	054	1	2023	Select Counties in Kansas and Missouri	Select Counties in Kansas City, MO-KS	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	054	2	1	02	01	H0028_054_2	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:35:47 PM Eastern Daylight Time	08/03/2022 04:15:15 PM Eastern Daylight Time	07/30/2022 05:17:30 AM Eastern Daylight Time			08/04/2022 10:43:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-054 (HMO-POS)	01	02		1			H0028	054	2	2023	Select Counties in Kansas and Missouri	Select Counties in Wichita	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	055	0	1	02	01	H0028_055_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:35:57 PM Eastern Daylight Time	08/03/2022 04:09:40 PM Eastern Daylight Time	07/30/2022 05:17:54 AM Eastern Daylight Time			08/04/2022 10:43:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP)	01	02		1			H0028	055	0	2023	Select Counties in Southwest Missouri		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	056	0	1	02	01	H0028_056_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:36:07 PM Eastern Daylight Time	08/03/2022 04:10:11 PM Eastern Daylight Time	07/30/2022 05:18:20 AM Eastern Daylight Time			08/04/2022 10:43:49 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP)	01	02		1			H0028	056	0	2023	Select Counties in Wichita		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	057	0	1	01	01	H0028_057_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:58:06 PM Eastern Daylight Time	08/03/2022 04:09:11 PM Eastern Daylight Time	07/30/2022 05:18:46 AM Eastern Daylight Time			08/04/2022 11:11:59 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H0028	057	0	2023	Select Counties in Des Moines and Cedar Rapids		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	058	0	1	01	01	H0028_058_0	4	1	2	1	1		0	06/06/2022	2023.01	06/06/2022 03:56:16 PM Eastern Daylight Time	08/03/2022 04:26:43 PM Eastern Daylight Time	07/30/2022 05:19:10 AM Eastern Daylight Time			08/04/2022 11:04:41 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-058 (HMO D-SNP)	01	01		1			H0028	058	0	2023	Select Counties in South Dakota		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	059	0	1	01	01	H0028_059_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 04:06:55 PM Eastern Daylight Time	08/03/2022 03:56:03 PM Eastern Daylight Time	07/30/2022 05:19:34 AM Eastern Daylight Time			08/04/2022 01:09:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-059 (HMO)	01	01		1			H0028	059	0	2023	Dallas area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						06/05/2022	2023.01	06/05/2022 01:04:33 PM Eastern Daylight Time					06/05/2022 01:07:19 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	801	0	2023	Select Counties in Multi States		1	39396	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 03:55:41 PM Eastern Daylight Time					06/03/2022 03:41:22 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	802	0	2023	Select Counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						05/27/2022	2023.01	05/27/2022 04:01:18 PM Eastern Daylight Time					06/03/2022 03:41:22 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	804	0	2023	Select Counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 04:04:33 PM Eastern Daylight Time					06/03/2022 03:41:22 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	805	0	2023	Select Counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	1	1						05/10/2022	2023.01	05/10/2022 09:47:41 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	COORDINATED CARE OF WASHINGTON, INC.	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H0029	801	0	2023	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)917-0175		(844)917-0175		(855)848-6940		(855)848-6940		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:29:27 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	COORDINATED CARE OF WASHINGTON, INC.	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H0029	802	0	2023	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)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 09:30:12 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	COORDINATED CARE OF WASHINGTON, INC.	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H0029	803	0	2023	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)917-0175		(844)917-0175		(855)848-6940		(855)848-6940		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	10	1	2	1			0	08/04/2022	2023.01	08/04/2022 10:25:51 AM Eastern Daylight Time	08/04/2022 03:46:38 PM Eastern Daylight Time	08/05/2022 11:03:06 AM Eastern Daylight Time			08/05/2022 12:15:48 PM Eastern Daylight Time	HAMASPIK, INC.	Hamaspik, Inc.	www.hamaspik.com	Hamaspik Medicare Select (HMO D-SNP)	01	01		1			H0034	001	0	2023	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					2	2			
H0034	002	0	1	01	01	H0034_002_0	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 10:27:47 AM Eastern Daylight Time	08/04/2022 03:46:12 PM Eastern Daylight Time	08/05/2022 11:04:48 AM Eastern Daylight Time			08/05/2022 12:14:26 PM Eastern Daylight Time	HAMASPIK, INC.	Hamaspik, Inc.	www.hamaspik.com	Hamaspik Medicare Choice (HMO D-SNP)	01	01		1			H0034	002	0	2023	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					2	2			
H0062	801	0	1	01	01	H0062_801_0	1	1						05/10/2022	2023.01	05/10/2022 09:31:05 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Wellcare by Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	01	01		1			H0062	801	0	2023	Texas		1	100	2			2									allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:31:56 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Wellcare by Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	01	01		1			H0062	802	0	2023	Texas		1	100	2			2									allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 09:37:00 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Wellcare by Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	01	01		1			H0062	803	0	2023	Texas		1	100	2			2									allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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						08/01/2022	2023.01	08/01/2022 12:37:24 PM Eastern Daylight Time	08/03/2022 08:18:20 PM Eastern Daylight Time	07/30/2022 07:04:20 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF MISSISSIPPI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H0074	001	0	2023	Select counties in MS		2		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						08/01/2022	2023.01	08/01/2022 12:47:20 PM Eastern Daylight Time	08/03/2022 08:19:33 PM Eastern Daylight Time	07/30/2022 07:04:54 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF MISSISSIPPI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Hybrid Open (PPO)	01	04		1			H0074	002	0	2023	Select counties in MS		2		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						06/01/2022	2023.01	06/01/2022 05:11:45 PM Eastern Daylight Time	08/03/2022 08:20:45 PM Eastern Daylight Time	07/30/2022 07:05:24 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF MISSISSIPPI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Community Assist (PPO)	01	04		1			H0074	003	0	2023	Select counties in MS		2		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	004	0	1	04	01	H0074_004_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:48:44 AM Eastern Daylight Time	08/03/2022 08:21:59 PM Eastern Daylight Time	07/30/2022 07:05:56 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF MISSISSIPPI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H0074	004	0	2023	Select counties in MS		2		2			1	3		1					1	www.WellCare.com/our_pharmacies/default	www.WellCare.com/medicare/medication_guide	www.wellcare.com/fap_search	(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	4	1						08/03/2022	2023.01	08/03/2022 02:17:53 PM Eastern Daylight Time	08/03/2022 07:37:27 PM Eastern Daylight Time	07/30/2022 07:06:27 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	5	1						08/03/2022	2023.01	08/03/2022 02:27:41 PM Eastern Daylight Time	08/03/2022 07:39:38 PM Eastern Daylight Time	07/30/2022 07:06:58 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	6	1					1	08/03/2022	2023.01	08/03/2022 03:25:50 PM Central Daylight Time	08/05/2022 10:44:46 AM Central Daylight Time	08/05/2022 10:44:57 AM Central Daylight Time			08/05/2022 10:50:49 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	2023	State of Alabama		2		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	08/03/2022	2023.01	08/03/2022 03:26:22 PM Central Daylight Time	08/05/2022 10:45:16 AM Central Daylight Time	08/05/2022 10:43:31 AM Central Daylight Time			08/05/2022 10:50:49 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	2023	Birmingham/Mobile		2		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	08/02/2022	2023.01	08/02/2022 01:54:55 PM Central Daylight Time	08/05/2022 10:43:49 AM Central Daylight Time	08/05/2022 10:44:00 AM Central Daylight Time			08/05/2022 11:38:13 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	2023	State of Alabama		2		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	05/16/2022	2023.01	05/16/2022 07:07:10 PM Central Daylight Time					06/05/2022 01:27:10 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	2023	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						06/03/2022	2023.01	06/03/2022 11:49:59 AM Central Daylight Time					06/06/2022 10:09:49 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	2023	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						06/02/2022	2023.01	06/02/2022 04:37:49 PM Central Daylight Time					06/05/2022 01:27:10 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	2023	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						06/05/2022	2023.01	06/05/2022 01:26:51 PM Central Daylight Time					06/05/2022 01:27:10 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	2023	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						06/05/2022	2023.01	06/05/2022 01:26:43 PM Central Daylight Time					06/05/2022 01:27:10 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	2023	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						06/03/2022	2023.01	06/03/2022 11:50:41 AM Central Daylight Time					06/06/2022 10:09:49 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	2023	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						06/05/2022	2023.01	06/05/2022 01:26:35 PM Central Daylight Time					06/05/2022 01:27:10 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	2023	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						06/03/2022	2023.01	06/03/2022 10:31:39 AM Central Daylight Time					06/05/2022 01:27:10 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	2023	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						06/06/2022	2023.01	06/06/2022 08:58:10 AM Eastern Daylight Time		06/03/2022 03:12:30 PM Eastern Daylight Time			06/06/2022 09:01:47 AM Eastern Daylight Time	Orangeburg Senior Helping Center, LLC	Orangeburg Senior Helping Center: A PACE Healthcar	https://www.orangeburgshcpace.com	Oaks of Orangeburg d.b.a. Orangeburg SHC Pace (PACE)	08	20		1			H0105	001	0	2023	Rural South Carolina		2		2			2									https://groveparkpharmacy.com/	www.groveparkpharmacy.com	https://www.orangeburgshcpace.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						06/06/2022	2023.01	06/06/2022 08:58:44 AM Eastern Daylight Time		06/03/2022 03:14:14 PM Eastern Daylight Time			06/06/2022 09:01:47 AM Eastern Daylight Time	Orangeburg Senior Helping Center, LLC	Orangeburg Senior Helping Center: A PACE Healthcar	https://www.orangeburgshcpace.com	Oaks of Orangeburg d.b.a. Orangeburg SHC Pace (PACE)	08	20		1			H0105	002	0	2023	Rural South Carolina		2		2			2									https://groveparkpharmacy.com/	www.groveparkpharmacy.com	https://www.orangeburgshcpace.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	6	1						07/05/2022	2023.01	07/05/2022 11:03:46 AM Central Daylight Time	08/05/2022 02:16:07 PM Central Daylight Time	08/03/2022 05:26:05 PM Central Daylight Time			08/05/2022 07:58:59 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H0107	003	0	2023	Montana		2		2			2									getbluemt.com/pharmacies	getbluemt.com/mapd/druglist	getbluemt.com/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	004	0	1	04	01	H0107_004_0	6	1						07/05/2022	2023.01	07/05/2022 11:04:03 AM Central Daylight Time	08/05/2022 02:18:29 PM Central Daylight Time	08/03/2022 05:27:29 PM Central Daylight Time			08/05/2022 07:58:59 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Medicare Advantage Optimum (PPO)	01	04		1			H0107	004	0	2023	Montana		2		2			2									getbluemt.com/mapd/pharmacies	getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	005	0	1	04	01	H0107_005_0	6	1						08/03/2022	2023.01	08/03/2022 10:59:36 AM Central Daylight Time	08/05/2022 02:20:50 PM Central Daylight Time	08/03/2022 05:28:49 PM Central Daylight Time			08/05/2022 07:58:59 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H0107	005	0	2023	Montana		2		2			2									getbluemt.com/mapd/pharmacies	getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	006	0	1	04	01	H0107_006_0	7	1						07/14/2022	2023.01	07/14/2022 12:48:09 PM Central Daylight Time	08/05/2022 02:23:10 PM Central Daylight Time	08/03/2022 05:30:10 PM Central Daylight Time			08/05/2022 07:58:59 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H0107	006	0	2023	Montana		2		2			2									getbluemt.com/mapd/pharmacies	getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	007	0	1	04	01	H0107_007_0	6	1						08/04/2022	2023.01	08/04/2022 10:08:54 AM Central Daylight Time	08/05/2022 02:25:29 PM Central Daylight Time	08/03/2022 05:31:29 PM Central Daylight Time			08/05/2022 07:58:59 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Medicare Advantage Dental Premier (PPO)	01	04		1			H0107	007	0	2023	Montana		2		2			2									getbluemt.com/pharmacies	getbluemt.com/mapd/druglist	getbluemt.com/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	801	0	1	04	01	H0107_801_0	3	1						06/01/2022	2023.01	06/01/2022 11:50:46 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	801	0	2023	Montana		1	28421	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	802	0	1	04	01	H0107_802_0	3	1						06/01/2022	2023.01	06/01/2022 11:51:22 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	802	0	2023	Montana		1	38853	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	803	0	1	04	01	H0107_803_0	3	1				0	0	06/01/2022	2023.01	06/01/2022 11:53:26 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	803	0	2023	State of Montana		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	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	3	1				0	0	06/01/2022	2023.01	06/01/2022 11:53:37 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	804	0	2023	State of Montana		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/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	3	1						06/01/2022	2023.01	06/01/2022 11:54:03 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	805	0	2023	Montana		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	806	0	1	04	01	H0107_806_0	3	1						06/01/2022	2023.01	06/01/2022 11:54:21 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	806	0	2023	Montana		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	807	0	1	04	01	H0107_807_0	3	1						06/01/2022	2023.01	06/01/2022 11:54:53 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	807	0	2023	Montana		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	808	0	1	04	01	H0107_808_0	3	1				0	0	06/01/2022	2023.01	06/01/2022 11:55:16 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	808	0	2023	MT		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0107	809	0	1	04	01	H0107_809_0	3	1				0	0	06/01/2022	2023.01	06/01/2022 11:58:24 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	809	0	2023	MT		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0107	810	0	1	04	01	H0107_810_0	3	1				0	0	06/01/2022	2023.01	06/01/2022 11:58:14 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	810	0	2023	MT		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0107	811	0	1	04	01	H0107_811_0	3	1				0	0	06/01/2022	2023.01	06/01/2022 11:58:00 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	811	0	2023	MT		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0107	812	0	1	04	01	H0107_812_0	3	1				0	0	06/01/2022	2023.01	06/01/2022 11:57:44 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	812	0	2023	MT		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0107	813	0	1	04	01	H0107_813_0	3	1				0	0	06/01/2022	2023.01	06/01/2022 11:57:29 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	813	0	2023	MT		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0107	814	0	1	04	01	H0107_814_0	3	1						06/01/2022	2023.01	06/01/2022 11:57:09 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	814	0	2023	MT		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	815	0	1	04	01	H0107_815_0	3	1						06/01/2022	2023.01	06/01/2022 11:56:31 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	815	0	2023	MT		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	816	0	1	04	01	H0107_816_0	3	1						06/01/2022	2023.01	06/01/2022 11:56:07 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	816	0	2023	MT		1	1	2			2									www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0111	001	0	1	04	01	H0111_001_0	4	1						08/03/2022	2023.01	08/03/2022 03:09:20 PM Eastern Daylight Time	08/03/2022 07:33:03 PM Central Daylight Time	07/30/2022 06:07:32 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H0111	001	0	2023	Select counties in GA		2		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						08/01/2022	2023.01	08/01/2022 11:11:03 AM Eastern Daylight Time	08/03/2022 07:34:41 PM Central Daylight Time	07/30/2022 06:08:03 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium Open (PPO)	01	04		1			H0111	002	0	2023	Select counties in GA		2		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						08/01/2022	2023.01	08/01/2022 11:12:16 AM Eastern Daylight Time	08/03/2022 07:36:15 PM Central Daylight Time	07/30/2022 06:08:34 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced Open (PPO)	01	04		1			H0111	003	0	2023	Select counties in GA		2		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	5	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 11:54:07 AM Eastern Daylight Time	08/03/2022 07:37:48 PM Central Daylight Time	07/30/2022 06:09:06 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H0111	004	0	2023	Select counties in GA		2		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			
H0112	001	0	1	20	08	H0112_001_0	1	1						06/03/2022	2023.01	06/03/2022 10:42:44 AM Eastern Daylight Time		06/03/2022 11:07:04 AM Eastern Daylight Time			06/03/2022 11:09:19 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	2023	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						06/03/2022	2023.01	06/03/2022 10:43:11 AM Eastern Daylight Time		06/03/2022 11:06:59 AM Eastern Daylight Time			06/03/2022 11:09:19 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	2023	Palm Beach County (partial)		2		2			2									MorseLife.org	N/A										(855)572-7223		(561)687-5745		(855)572-7223		(561)687-5745										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771																
H0137	001	0	1	48	05	H0137_001_0	2	1						06/27/2022	2023.01	06/27/2022 05:18:26 PM Eastern Daylight Time					06/27/2022 05:19:42 PM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance Massachusetts	www.commonwealthcarealliance.org/become-a-member	CCA One Care (Medicare-Medicaid Plan)	05	48		1			H0137	001	0	2023	BERK BAR BRI ESS FRA HMD HMP MID NOR PLY SUF WOR		2	390352	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)-																
H0154	008	0	1	01	01	H0154_008_0	5	1			2	0	0	07/01/2022	2023.01	07/01/2022 04:13:26 PM Central Daylight Time	07/14/2022 10:31:36 AM Central Daylight Time				07/14/2022 10:37:30 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Select (HMO)	01	01		1			H0154	008	0	2023	North, Central, and South Alabama		2		2			2									www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	www.vivahealth.com/Medicare/Provider-Search	(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			2			08/04/2022	2023.01	08/04/2022 06:37:12 PM Central Daylight Time	08/05/2022 12:02:37 PM Central Daylight Time	08/05/2022 12:02:37 PM Central Daylight Time			08/05/2022 01:55:28 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Premier (HMO)	01	01		1			H0154	011	0	2023	Northwest, Central and South Alabama		2		2			2									www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/Provider-Search	(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	1		0	08/04/2022	2023.01	08/04/2022 06:39:13 PM Central Daylight Time	08/05/2022 12:02:37 PM Central Daylight Time	08/05/2022 12:02:38 PM Central Daylight Time			08/05/2022 01:55:28 PM 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	2023	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/Provider-Search	(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			2			08/04/2022	2023.01	08/04/2022 06:41:10 PM Central Daylight Time	08/05/2022 12:02:38 PM Central Daylight Time	08/05/2022 12:02:38 PM Central Daylight Time			08/05/2022 01:55:28 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Me (HMO)	01	01		1			H0154	014	0	2023	Central, Southeast and East Alabama		2		2			2									www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/Provider-Search	(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			2			08/04/2022	2023.01	08/04/2022 06:42:59 PM Central Daylight Time	08/05/2022 12:02:39 PM Central Daylight Time	08/05/2022 12:02:39 PM Central Daylight Time			08/05/2022 01:55:28 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Plus (HMO)	01	01		1			H0154	015	1	2023	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/Provider-Search	(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			2			08/04/2022	2023.01	08/04/2022 06:44:53 PM Central Daylight Time	08/05/2022 12:02:40 PM Central Daylight Time	08/05/2022 12:02:40 PM Central Daylight Time			08/05/2022 01:55:28 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Plus (HMO)	01	01		1			H0154	015	2	2023	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/Provider-Search	(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			2			08/04/2022	2023.01	08/04/2022 06:46:44 PM Central Daylight Time	08/05/2022 12:02:40 PM Central Daylight Time	08/05/2022 12:02:41 PM Central Daylight Time			08/05/2022 01:55:28 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Prime (HMO)	01	01		1			H0154	016	0	2023	Northwest, Central and South Alabama		2		2			2									www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/Provider-Search	(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			2			08/04/2022	2023.01	08/04/2022 06:49:10 PM Central Daylight Time	08/05/2022 12:02:41 PM Central Daylight Time	08/05/2022 12:02:41 PM Central Daylight Time			08/05/2022 01:55:28 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Classic (HMO)	01	01		1			H0154	017	0	2023	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/Provider-Search	(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			2			08/04/2022	2023.01	08/04/2022 06:52:09 PM Central Daylight Time	08/05/2022 12:02:42 PM Central Daylight Time	08/05/2022 12:02:35 PM Central Daylight Time			08/05/2022 01:55:28 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Preferred (HMO)	01	01		1			H0154	018	0	2023	Limestone, Madison, Marshall and Morgan Counties		2		2			2									www.vivahealth.com/Medicare/#PharmacyDirectories	www.vivahealth.com/Medicare/#Formularies	www.vivahealth.com/Medicare/Provider-Search	(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	1		0	08/04/2022	2023.01	08/04/2022 08:14:09 PM Central Daylight Time	08/05/2022 12:02:35 PM Central Daylight Time	08/05/2022 12:02:36 PM Central Daylight Time			08/05/2022 01:55:28 PM 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	2023	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/Provider-Search	(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			2			08/04/2022	2023.01	08/04/2022 08:11:39 PM Central Daylight Time	08/05/2022 12:02:36 PM Central Daylight Time	08/05/2022 12:02:36 PM Central Daylight Time			08/05/2022 01:55:28 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Infirmary Health Advantage (HMO)	01	01		1			H0154	020	0	2023	Baldwin and Mobile Counties		2		2			2									www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/Provider-Search	(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	3	1						06/03/2022	2023.01	06/03/2022 11:26:14 AM Central Daylight Time					06/06/2022 11:04:35 AM 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	2023	State of Alabama		1	450	2			2									www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/Provider-Search	(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;9a1;9a2;9b;10a;11a;11b;12;15;	2		1					1				
H0154	802	0	1	01	01	H0154_802_0	3	1				0	0	06/01/2022	2023.01	06/01/2022 06:12:12 PM Central Daylight Time					06/06/2022 11:04:35 AM 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	2023	State of Alabama		1	70	2			2									www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	www.vivahealth.com/Medicare/Provider-Search	(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	3	1						06/01/2022	2023.01	06/01/2022 06:12:30 PM Central Daylight Time					06/06/2022 11:04:35 AM 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	2023	State of Alabama		1	250	2			2									www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/Provider-Search	(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				
H0169	001	0	1	02	01	H0169_001_0	5	1	2	1	1		0	08/05/2022	2023.01	08/05/2022 10:50:03 AM Central Daylight Time	08/03/2022 10:39:53 AM Central Daylight Time	07/30/2022 11:02:07 PM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H0169	001	0	2023	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	02	01	H0169_002_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 03:35:03 PM Central Daylight Time	08/03/2022 10:40:34 AM Central Daylight Time	07/30/2022 11:02:32 PM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H0169	002	0	2023	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	02	01	H0169_003_0	4	1	2	1	1		0	08/05/2022	2023.01	08/05/2022 10:56:26 AM Central Daylight Time	08/03/2022 10:41:13 AM Central Daylight Time	07/30/2022 11:02:57 PM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)	01	02		1			H0169	003	0	2023	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	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 03:34:04 PM Central Daylight Time	08/03/2022 10:41:52 AM Central Daylight Time	07/30/2022 11:03:22 PM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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			
H0169	006	0	1	02	01	H0169_006_0	4	1	2	1	1		0	08/05/2022	2023.01	08/05/2022 10:56:34 AM Central Daylight Time	08/03/2022 10:42:31 AM Central Daylight Time	07/30/2022 11:03:46 PM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H0169	006	0	2023	Select Counties in Nebraska		2		2			1	3		2					2	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	008	0	1	02	01	H0169_008_0	5	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 09:08:53 AM Central Daylight Time	08/03/2022 10:43:10 AM Central Daylight Time	07/30/2022 11:04:11 PM Central Daylight Time			08/12/2022 09:14:40 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H0169	008	0	2023	State of Missouri		2		2			1	3		2					2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7149		(844)368-7149		(888)834-3721		(888)834-3721		(844)368-7149		(844)368-7149		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	002	0	1	01	01	H0174_002_0	4	1						08/01/2022	2023.01	08/01/2022 04:54:00 PM Eastern Daylight Time	08/03/2022 07:55:54 PM Eastern Daylight Time	07/30/2022 07:09:36 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus No Premium (HMO)	01	01		1			H0174	002	0	2023	Select counties in TX		2		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	5	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 08:48:45 PM Pacific Daylight Time	08/03/2022 07:56:53 PM Eastern Daylight Time	07/30/2022 07:10:08 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		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	5	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 08:51:38 PM Pacific Daylight Time	08/03/2022 07:57:51 PM Eastern Daylight Time	07/30/2022 07:10:40 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		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	2		1	08/01/2022	2023.01	08/01/2022 04:59:43 PM Eastern Daylight Time	08/03/2022 07:58:50 PM Eastern Daylight Time	07/30/2022 07:11:10 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		2			1	4			00000000000000000010000					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						07/14/2022	2023.01	07/14/2022 04:43:06 PM Pacific Daylight Time	08/03/2022 07:59:47 PM Eastern Daylight Time	07/30/2022 07:11:41 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H0174	009	0	2023	Select counties in TX		2		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						08/01/2022	2023.01	08/01/2022 05:03:12 PM Eastern Daylight Time	08/03/2022 08:00:46 PM Eastern Daylight Time	07/30/2022 07:12:12 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H0174	010	0	2023	Select counties in TX		2		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						08/01/2022	2023.01	08/01/2022 05:05:19 PM Eastern Daylight Time	08/03/2022 08:01:45 PM Eastern Daylight Time	07/30/2022 07:12:43 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus No Premium (HMO)	01	01		1			H0174	014	0	2023	Select counties in TX		2		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	015	0	1	01	01	H0174_015_0	5	1						08/01/2022	2023.01	08/01/2022 05:09:31 PM Eastern Daylight Time	08/03/2022 08:02:43 PM Eastern Daylight Time	07/30/2022 07:13:14 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H0174	015	0	2023	Select Counties in Texas		2		2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	016	0	1	01	01	H0174_016_0	4	1						08/01/2022	2023.01	08/01/2022 05:19:31 PM Eastern Daylight Time	08/03/2022 08:03:41 PM Eastern Daylight Time	07/30/2022 07:13:45 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H0174	016	0	2023	Select Counties in Texas		2		2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	017	0	1	01	01	H0174_017_0	4	1						08/03/2022	2023.01	08/03/2022 02:27:52 PM Eastern Daylight Time	08/03/2022 08:04:40 PM Eastern Daylight Time	07/30/2022 07:14:17 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	017	0	2023	Select Counties in Texas		2		2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	018	0	1	01	01	H0174_018_0	4	1						08/03/2022	2023.01	08/03/2022 02:28:53 PM Eastern Daylight Time	08/03/2022 08:05:39 PM Eastern Daylight Time	07/30/2022 07:14:47 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	018	0	2023	Select Counties in Texas		2		2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	019	0	1	01	01	H0174_019_0	4	1						08/03/2022	2023.01	08/03/2022 02:29:49 PM Eastern Daylight Time	08/03/2022 08:06:37 PM Eastern Daylight Time	07/30/2022 07:15:18 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	019	0	2023	Select Counties in Texas		2		2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	020	0	1	01	01	H0174_020_0	4	1						08/03/2022	2023.01	08/03/2022 02:30:49 PM Eastern Daylight Time	08/03/2022 08:07:35 PM Eastern Daylight Time	07/30/2022 07:15:49 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	020	0	2023	Select Counties in Texas		2		2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	021	0	1	01	01	H0174_021_0	4	1						08/01/2022	2023.01	08/01/2022 05:32:34 PM Eastern Daylight Time	08/03/2022 08:08:34 PM Eastern Daylight Time	07/30/2022 07:16:20 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	021	0	2023	Select Counties in Texas		2		2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0192	001	0	1	48	05	H0192_001_0	5	1						05/26/2023	2023.01	05/26/2023 02:56:55 PM Eastern Daylight Time					05/26/2023 02:59:31 PM Eastern 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	2023	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						06/03/2022	2023.01	06/03/2022 04:49:06 PM Central Daylight Time		06/02/2022 07:29:54 AM Central Daylight Time			06/03/2022 04:53:10 PM Central Daylight Time	PACE IOWA	Immanuel Pathways Iowa	Immanuel.com	PACE Iowa (PACE)	08	20		1			H0216	001	0	2023	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						06/03/2022	2023.01	06/03/2022 04:49:43 PM Central Daylight Time		06/02/2022 07:29:54 AM Central Daylight Time			06/03/2022 04:53:10 PM Central Daylight Time	PACE IOWA	Immanuel Pathways Iowa	Immanuel.com	PACE Iowa (PACE)	08	20		1			H0216	002	0	2023	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	1	1						06/01/2022	2023.01	06/01/2022 02:07:13 PM US Eastern Daylight Time		06/01/2022 01:19:43 PM US Eastern Daylight Time			06/01/2022 02:08:39 PM US Eastern Daylight Time	PACE OF NORTHEAST INDIANA, LLC	PACE of Northeast Indiana, LLC	www.pacenein.org	PACE of NE IN - Dual Eligible (PACE)	08	20		1			H0235	001	0	2023	Allen		2		2			2									https://agingihs.org	https://agingihs.org/												(260)469-4148				(260)469-4148												(711)-				(711)-																
H0235	002	0	1	20	08	H0235_002_0	1	1						06/01/2022	2023.01	06/01/2022 02:06:41 PM US Eastern Daylight Time		06/01/2022 01:19:43 PM US Eastern Daylight Time			06/01/2022 02:08:39 PM US Eastern Daylight Time	PACE OF NORTHEAST INDIANA, LLC	PACE of Northeast Indiana, LLC	www.pacenein.org	PACE of NE IN - Medicare Only (PACE)	08	20		1			H0235	002	0	2023	Allen		2		2			2									https://agingihs.org	https://agingihs.org/												(260)469-4148				(260)469-4148												(711)-				(711)-																
H0247	001	0	1	20	08	H0247_001_0	1	1						06/03/2022	2023.01	06/03/2022 09:42:03 AM Pacific Daylight Time		06/03/2022 09:41:23 AM Pacific Daylight Time			06/03/2022 10:21:20 AM Pacific Daylight Time	ALLCARE PACE, LLC	AllCare PACE, LLC	www.allcarehealth.com	AllCare PACE - Dual Eligible (PACE)	08	20		1			H0247	001	0	2023	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						06/03/2022	2023.01	06/03/2022 09:41:55 AM Pacific Daylight Time		06/03/2022 09:41:23 AM Pacific Daylight Time			06/03/2022 10:21:20 AM Pacific Daylight Time	ALLCARE PACE, LLC	AllCare PACE, LLC	www.allcarehealth.com	AllCare PACE - Medicare Only (PACE)	08	20		1			H0247	002	0	2023	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	02	01	H0251_002_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 02:17:35 PM Central Daylight Time	08/03/2022 10:18:35 AM Central Daylight Time	07/30/2022 11:04:36 PM Central Daylight Time			08/04/2022 02:31:06 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H0251	002	0	2023	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	02	01	H0251_004_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:27:31 AM Central Daylight Time	08/03/2022 10:19:19 AM Central Daylight Time	07/30/2022 11:05:00 PM Central Daylight Time			08/04/2022 02:31:06 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP)	01	02		1			H0251	004	0	2023	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						08/01/2022	2023.01	08/01/2022 11:45:56 AM Eastern Daylight Time	08/03/2022 09:52:17 PM Eastern Daylight Time	07/30/2022 07:16:50 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:52:26 AM Eastern Daylight Time	08/03/2022 09:54:00 PM Eastern Daylight Time	07/30/2022 07:17:22 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		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	005	0	1	04	01	H0271_005_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 10:22:55 AM Central Daylight Time	08/03/2022 11:14:59 AM Central Daylight Time	07/30/2022 11:05:25 PM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H0271	005	0	2023	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	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:49:43 PM Central Daylight Time	08/03/2022 11:15:37 AM Central Daylight Time	07/30/2022 11:05:50 PM Central Daylight Time			08/04/2022 02:16:39 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H0271	006	0	2023	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	2	1			2		0	08/02/2022	2023.01	08/02/2022 04:51:01 PM Central Daylight Time	08/03/2022 11:16:14 AM Central Daylight Time	07/30/2022 11:06:14 PM Central Daylight Time			08/04/2022 02:16:39 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	007	0	2023	State of 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	012	0	1	04	01	H0271_012_0	3	1			2		0	07/19/2022	2023.01	07/19/2022 09:48:22 AM Central Daylight Time	08/03/2022 11:16:51 AM Central Daylight Time	07/30/2022 11:06:39 PM Central Daylight Time			08/04/2022 02:16:39 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	012	0	2023	State of 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	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:11:21 PM Central Daylight Time	08/03/2022 11:17:29 AM Central Daylight Time	07/30/2022 11:07:03 PM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	013	0	2023	State of 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	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 08:59:50 AM Central Daylight Time	08/03/2022 11:18:07 AM Central Daylight Time	07/30/2022 11:07:28 PM Central Daylight Time			08/04/2022 02:16:39 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H0271	014	0	2023	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	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 01:00:45 PM Central Daylight Time	08/03/2022 11:18:45 AM Central Daylight Time	07/30/2022 11:07:53 PM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	016	0	2023	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	4	1			2		0	08/05/2022	2023.01	08/05/2022 10:56:47 AM Central Daylight Time	08/03/2022 11:19:22 AM Central Daylight Time	07/30/2022 11:08:17 PM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	017	0	2023	Select Counties in North Dakota		2		2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			
H0271	020	0	1	04	01	H0271_020_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:52:51 PM Central Daylight Time	08/03/2022 11:20:00 AM Central Daylight Time	07/30/2022 11:08:41 PM Central Daylight Time			08/04/2022 02:16:39 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare NorthernLightHealth Dual Complete (PPO D-SNP)	01	04		1			H0271	020	0	2023	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	023	0	1	04	01	H0271_023_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 02:58:38 PM Central Daylight Time	08/03/2022 11:20:38 AM Central Daylight Time	07/30/2022 11:09:06 PM Central Daylight Time			08/04/2022 02:35:32 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	023	0	2023	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	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 03:02:51 PM Central Daylight Time	08/03/2022 11:21:16 AM Central Daylight Time	07/30/2022 11:09:31 PM Central Daylight Time			08/04/2022 02:35:32 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice Select (PPO D-SNP)	01	04		1			H0271	024	0	2023	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	2	1		1	2		0	06/01/2022	2023.01	06/01/2022 09:07:10 AM Central Daylight Time	08/03/2022 11:21:54 AM Central Daylight Time	07/30/2022 11:09:56 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	025	0	2023	Graham, Santa Cruz, and Yavapai counties		2		2			1	4			00000000000000000010000					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	08/03/2022	2023.01	08/03/2022 03:42:10 PM Central Daylight Time	08/03/2022 11:22:31 AM Central Daylight Time	07/30/2022 11:10:20 PM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	026	0	2023	Select Counties in Illinois		2		2			1	4			00000000000000000010000					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	06/02/2022	2023.01	06/02/2022 11:22:09 AM Central Daylight Time	08/03/2022 11:23:09 AM Central Daylight Time	07/30/2022 11:10:45 PM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	027	0	2023	Select Counties in Illinois		2		2			1	4			00000000000000000010000					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	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 03:48:14 PM Central Daylight Time	08/03/2022 11:23:47 AM Central Daylight Time	07/30/2022 11:11:11 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	028	0	2023	Select Counties in Michigan		2		2			1	3		1					1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	029	0	1	04	01	H0271_029_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 03:49:56 PM Central Daylight Time	08/03/2022 11:24:25 AM Central Daylight Time	07/30/2022 11:11:35 PM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	029	0	2023	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	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 09:08:23 AM Central Daylight Time	08/03/2022 11:25:03 AM Central Daylight Time	07/30/2022 11:12:00 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	030	0	2023	Select Counties in Montana		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	033	0	1	04	01	H0271_033_0	2	1		1	2		0	06/01/2022	2023.01	06/01/2022 09:06:03 AM Central Daylight Time	08/03/2022 11:25:41 AM Central Daylight Time	07/30/2022 11:12:24 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	033	0	2023	Select Counties in New Mexico		2		2			1	4			00000000000000000010000					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	08/03/2022	2023.01	08/03/2022 05:36:42 PM Central Daylight Time	08/03/2022 11:26:17 AM Central Daylight Time	07/30/2022 11:12:48 PM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	034	0	2023	Dona Ana, Grant, Hidalgo, Luna, Sierra counties		2		2			1	4			00000000000000000010000					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	2	1		1	2		0	06/01/2022	2023.01	06/01/2022 09:04:44 AM Central Daylight Time	08/03/2022 11:26:55 AM Central Daylight Time	07/30/2022 11:13:12 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	035	0	2023	Select Counties in New Mexico		2		2			1	4			00000000000000000010000					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	08/04/2022	2023.01	08/04/2022 01:28:22 PM Central Daylight Time	08/03/2022 11:27:33 AM Central Daylight Time	07/30/2022 11:13:36 PM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	036	0	2023	Select Counties in Oregon		2		2			1	4			00000000000000000010000					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	08/05/2022	2023.01	08/05/2022 10:56:54 AM Central Daylight Time	08/03/2022 11:28:10 AM Central Daylight Time	07/30/2022 11:14:01 PM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	037	0	2023	Select Counties in South Dakota		2		2			1	3		1					1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)203-5461		(800)203-5461		(888)834-3721		(888)834-3721		(800)203-5461		(800)203-5461		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	038	0	1	04	01	H0271_038_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 02:47:26 PM Central Daylight Time	08/03/2022 11:28:48 AM Central Daylight Time	07/30/2022 11:14:25 PM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	038	0	2023	Select Counties in Utah		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	039	0	1	04	01	H0271_039_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 02:47:34 PM Central Daylight Time	08/03/2022 11:29:25 AM Central Daylight Time	07/30/2022 11:14:49 PM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Select (PPO D-SNP)	01	04		1			H0271	039	0	2023	Select Counties in Utah		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	042	0	1	04	01	H0271_042_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 09:08:48 AM Central Daylight Time	08/03/2022 11:30:03 AM Central Daylight Time	07/30/2022 11:15:13 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	042	0	2023	Select Counties in Wyoming		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	043	0	1	04	01	H0271_043_0	3	1		1	2		0	08/04/2022	2023.01	08/04/2022 10:21:01 AM Central Daylight Time	08/03/2022 11:30:41 AM Central Daylight Time	07/30/2022 11:15:37 PM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	043	0	2023	Select counties in Idaho		2		2			1	4			00000000000000000010000					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	044	0	1	04	01	H0271_044_0	3	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 11:58:40 AM Central Daylight Time	08/03/2022 11:31:18 AM Central Daylight Time	07/30/2022 11:16:02 PM Central Daylight Time			08/12/2022 12:10:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	044	0	2023	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			
H0271	045	0	1	04	01	H0271_045_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:02:41 PM Central Daylight Time	08/03/2022 11:31:55 AM Central Daylight Time	07/30/2022 11:16:26 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice Select (PPO D-SNP)	01	04		1			H0271	045	0	2023	Select Counties in Colorado		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			
H0271	046	0	1	04	01	H0271_046_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:13:28 PM Central Daylight Time	08/03/2022 11:32:34 AM Central Daylight Time	07/30/2022 11:16:50 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	046	0	2023	Select Counties in Colorado		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	049	0	1	04	01	H0271_049_0	6	1		1	2		0	08/05/2022	2023.01	08/05/2022 10:57:02 AM Central Daylight Time	08/03/2022 11:33:12 AM Central Daylight Time	07/30/2022 11:17:14 PM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	049	0	2023	Select Counties in Iowa		2		2			1	4			00000000000000000010000					www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			
H0271	050	0	1	04	01	H0271_050_0	4	1	2	1	1		0	08/05/2022	2023.01	08/05/2022 10:57:08 AM Central Daylight Time	08/03/2022 11:33:49 AM Central Daylight Time	07/30/2022 11:17:38 PM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	050	0	2023	Select Counties in Nebraska		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			
H0271	052	0	1	04	01	H0271_052_0	3	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:53:52 PM Central Daylight Time	08/03/2022 11:34:26 AM Central Daylight Time	07/30/2022 11:18:02 PM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (PPO C-SNP)	01	04		1			H0271	052	0	2023	State of Missouri		2		2			1	4			00000000000000000010000					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	053	0	1	04	01	H0271_053_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 03:57:53 PM Central Daylight Time	08/03/2022 11:35:03 AM Central Daylight Time	07/30/2022 11:18:27 PM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	053	0	2023	State of Oklahoma		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	054	0	1	04	01	H0271_054_0	4	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 10:25:57 AM Central Daylight Time	08/03/2022 11:35:40 AM Central Daylight Time	07/30/2022 11:18:51 PM Central Daylight Time			08/12/2022 01:40:29 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice Select (PPO D-SNP)	01	04		1			H0271	054	0	2023	State of Indiana		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	055	0	1	04	01	H0271_055_0	5	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 10:33:13 AM Central Daylight Time	08/03/2022 11:36:17 AM Central Daylight Time	07/30/2022 11:19:15 PM Central Daylight Time			08/12/2022 01:40:29 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	055	0	2023	State of Ohio		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	056	0	1	04	01	H0271_056_0	3	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 08:43:14 AM Central Daylight Time	08/03/2022 11:36:55 AM Central Daylight Time	07/30/2022 11:19:39 PM Central Daylight Time			08/12/2022 10:01:01 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Select (PPO D-SNP)	01	04		1			H0271	056	0	2023	State of South Carolina		2		2			1	3		2					2	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	057	0	1	04	01	H0271_057_0	2	1		1	2		1	08/02/2022	2023.01	08/02/2022 08:44:11 AM Central Daylight Time	08/03/2022 11:37:32 AM Central Daylight Time	07/30/2022 11:20:03 PM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (PPO C-SNP)	01	04		1			H0271	057	0	2023	Select counties in South Carolina		2		2			1	4			00000000000000000010000					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	058	0	1	04	01	H0271_058_0	3	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 08:45:52 AM Central Daylight Time	08/03/2022 11:38:10 AM Central Daylight Time	07/30/2022 11:20:28 PM Central Daylight Time			08/12/2022 10:01:01 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice Select (PPO D-SNP)	01	04		1			H0271	058	0	2023	State of West Virgina		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	059	0	1	04	01	H0271_059_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:07:32 AM Central Daylight Time	08/03/2022 11:38:47 AM Central Daylight Time	07/30/2022 11:20:52 PM Central Daylight Time			08/04/2022 02:16:39 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Balance (PPO D-SNP)	01	04		1			H0271	059	0	2023	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	060	1	1	04	01	H0271_060_1	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:36:19 AM Central Daylight Time	08/03/2022 11:39:25 AM Central Daylight Time	07/30/2022 11:21:16 PM Central Daylight Time			08/04/2022 03:59:26 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	060	1	2023	Select Counties in New York	Select Counties in Upstate NY	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			
H0271	060	2	1	04	01	H0271_060_2	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:36:30 AM Central Daylight Time	08/03/2022 11:40:03 AM Central Daylight Time	07/30/2022 11:21:40 PM Central Daylight Time			08/04/2022 03:59:26 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	060	2	2023	Select Counties in New York	Select Counties Downstate NY	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			
H0292	001	0	1	01	01	H0292_001_0	5	1			1		1	08/01/2022	2023.01	08/01/2022 12:40:41 PM Eastern Daylight Time	08/03/2022 04:38:17 PM Eastern Daylight Time	07/30/2022 05:20:00 AM Eastern Daylight Time			08/04/2022 12:19:29 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H0292	001	0	2023	Select counties in Northern Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0292	002	0	1	01	01	H0292_002_0	4	1			1		1	05/29/2022	2023.01	05/29/2022 11:04:18 AM Eastern Daylight Time	08/03/2022 04:40:42 PM Eastern Daylight Time	07/30/2022 05:20:26 AM Eastern Daylight Time			08/04/2022 12:19:29 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	2023	Select counties in Northern Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	003	0	1	01	01	H0292_003_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:31:10 PM Eastern Daylight Time	08/03/2022 04:46:03 PM Eastern Daylight Time	07/30/2022 05:20:50 AM Eastern Daylight Time			08/04/2022 12:35:10 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0292-003 (HMO)	01	01		1			H0292	003	0	2023	Select counties in Northern Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1		1	2		1	05/31/2022	2023.01	05/31/2022 12:36:49 PM Central Daylight Time	08/03/2022 11:59:37 AM Central Daylight Time	07/30/2022 11:22:05 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (PPO C-SNP)	01	04		1			H0294	002	0	2023	Select counties in Wisconsin		2		2			1	4			00000000000000000010000					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	2	1			2		1	05/31/2022	2023.01	05/31/2022 12:38:17 PM Central Daylight Time	08/03/2022 12:00:13 PM Central Daylight Time	07/30/2022 11:22:29 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 1 (PPO)	01	04		1			H0294	004	0	2023	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	2	1		1	2		1	05/31/2022	2023.01	05/31/2022 12:40:12 PM Central Daylight Time	08/03/2022 12:00:48 PM Central Daylight Time	07/30/2022 11:22:53 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (PPO C-SNP)	01	04		1			H0294	010	0	2023	Select counties in Wisconsin		2		2			1	4			00000000000000000010000					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	2	1			2		1	08/04/2022	2023.01	08/04/2022 04:22:29 PM Central Daylight Time	08/03/2022 12:01:25 PM Central Daylight Time	07/30/2022 11:23:17 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open (PPO)	01	04		1			H0294	011	0	2023	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	2	1			2		1	05/31/2022	2023.01	05/31/2022 02:23:00 PM Central Daylight Time	08/03/2022 12:02:01 PM Central Daylight Time	07/30/2022 11:23:41 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Premier (PPO)	01	04		1			H0294	012	0	2023	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			2	0	0	05/31/2022	2023.01	05/31/2022 02:25:28 PM Central Daylight Time	06/01/2022 11:19:02 AM Central Daylight Time				06/03/2022 02:28:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot Plan 1 (PPO)	01	04		1			H0294	014	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 09:48:39 AM Central Daylight Time	08/03/2022 12:02:37 PM Central Daylight Time	07/30/2022 11:24:05 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H0294	015	0	2023	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	2	1			2		1	05/31/2022	2023.01	05/31/2022 02:34:03 PM Central Daylight Time	08/03/2022 12:03:16 PM Central Daylight Time	07/30/2022 11:24:29 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 2 (PPO)	01	04		1			H0294	016	0	2023	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			2		1	08/02/2022	2023.01	08/02/2022 10:28:34 AM Central Daylight Time	08/03/2022 12:03:57 PM Central Daylight Time	07/30/2022 11:24:53 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 1 (PPO)	01	04		1			H0294	017	0	2023	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	2	1			2		1	08/04/2022	2023.01	08/04/2022 04:22:49 PM Central Daylight Time	08/03/2022 12:04:34 PM Central Daylight Time	07/30/2022 11:25:16 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 2 (PPO)	01	04		1			H0294	018	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 11:21:02 AM Central Daylight Time	08/03/2022 12:05:11 PM Central Daylight Time	07/30/2022 11:25:40 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 1 (PPO)	01	04		1			H0294	019	0	2023	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	2	1			2		1	08/04/2022	2023.01	08/04/2022 04:13:56 PM Central Daylight Time	08/03/2022 12:05:48 PM Central Daylight Time	07/30/2022 11:26:05 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 2 (PPO)	01	04		1			H0294	020	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 11:33:04 AM Central Daylight Time	08/03/2022 12:06:24 PM Central Daylight Time	07/30/2022 11:26:29 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open (PPO)	01	04		1			H0294	021	0	2023	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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 02:47:44 PM Central Daylight Time	06/01/2022 11:25:12 AM Central Daylight Time				06/03/2022 02:28:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H0294	022	0	2023	Select Counties in Michigan		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			
H0294	023	0	1	04	01	H0294_023_0	4	1			2		1	08/05/2022	2023.01	08/05/2022 10:57:22 AM Central Daylight Time	08/03/2022 12:07:00 PM Central Daylight Time	07/30/2022 11:26:52 PM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H0294	023	0	2023	Select Counties in Western Wisconsin		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			
H0294	024	0	1	04	01	H0294_024_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 11:37:56 AM Central Daylight Time	08/03/2022 12:07:37 PM Central Daylight Time	07/30/2022 11:27:16 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open (PPO)	01	04		1			H0294	024	0	2023	Select Counties in Eastern 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	025	0	1	04	01	H0294_025_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 11:54:57 AM Central Daylight Time	08/03/2022 12:08:17 PM Central Daylight Time	07/30/2022 11:27:40 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Flex (PPO)	01	04		1			H0294	025	0	2023	Select Counties in Eastern 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	026	0	1	04	01	H0294_026_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 11:59:20 AM Central Daylight Time	08/03/2022 12:08:54 PM Central Daylight Time	07/30/2022 11:28:04 PM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 3 (PPO)	01	04		1			H0294	026	0	2023	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	027	0	1	04	01	H0294_027_0	4	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 09:27:27 AM Central Daylight Time	08/03/2022 12:09:32 PM Central Daylight Time	07/30/2022 11:28:28 PM Central Daylight Time			08/12/2022 11:37:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0294	027	0	2023	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			
H0302	001	0	1	01	01	H0302_001_0	10	1						07/08/2022	2023.01	07/08/2022 04:51:01 PM US Mountain Standard Time	08/02/2022 02:29:59 PM US Mountain Standard Time	08/01/2022 03:45:54 PM US Mountain Standard Time			08/04/2022 02:48:51 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	2023	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	10	1						08/04/2022	2023.01	08/04/2022 02:25:56 PM US Mountain Standard Time	08/04/2022 08:59:16 AM US Mountain Standard Time	08/01/2022 03:46:02 PM US Mountain Standard Time			08/04/2022 02:48:51 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	2023	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	10	1						08/02/2022	2023.01	08/02/2022 03:09:14 PM US Mountain Standard Time	08/03/2022 10:08:24 AM US Mountain Standard Time	08/01/2022 03:46:11 PM US Mountain Standard Time			08/04/2022 02:48:51 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	2023	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	10	1						08/02/2022	2023.01	08/02/2022 03:11:38 PM US Mountain Standard Time	08/03/2022 10:15:13 AM US Mountain Standard Time	08/01/2022 03:46:20 PM US Mountain Standard Time			08/04/2022 02:48:51 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	2023	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	4	1				0	0	06/02/2022	2023.01	06/02/2022 02:28:37 PM US Mountain Standard Time					06/03/2022 09:10:38 AM 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	2023	Arizona		1	0	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	02	01	H0321_002_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 08:34:10 AM Central Daylight Time	08/03/2022 10:49:13 AM Central Daylight Time	07/30/2022 11:28:53 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO-POS D-SNP)	01	02		1			H0321	002	0	2023	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	02	01	H0321_004_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 08:34:19 AM Central Daylight Time	08/03/2022 10:49:52 AM Central Daylight Time	07/30/2022 11:29:17 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP)	01	02		1			H0321	004	0	2023	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	06/21/2022	2023.01	06/21/2022 05:28:39 PM Central Daylight Time	06/05/2022 12:01:10 PM Central Daylight Time				06/28/2022 02:31:46 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Silver (HMO)	01	01		1			H0332	001	0	2023	BO,FB,FV,HR, and MQ counties		2		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	08/03/2022	2023.01	08/03/2022 11:07:11 AM Central Daylight Time	08/04/2022 10:55:14 AM Central Daylight Time	08/04/2022 10:55:14 AM Central Daylight Time			08/04/2022 11:07:58 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Gold (HMO)	01	01		1			H0332	002	0	2023	BO,FB,FV,HR, and MQ counties		2		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	06/21/2022	2023.01	06/21/2022 05:30:11 PM Central Daylight Time	06/05/2022 12:01:10 PM Central Daylight Time				06/28/2022 02:31:46 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Silver Freedom (HMO-POS)	01	02		1			H0332	003	0	2023	BO,FB,FV,HR, and MQ counties		2		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	08/03/2022	2023.01	08/03/2022 11:07:39 AM Central Daylight Time	08/04/2022 10:55:14 AM Central Daylight Time	08/04/2022 10:55:14 AM Central Daylight Time			08/04/2022 11:07:58 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Gold Freedom (HMO-POS)	01	02		1			H0332	004	0	2023	BO,FB,FV,HR, and MQ counties		2		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	06/21/2022	2023.01	06/21/2022 05:31:27 PM Central Daylight Time	06/05/2022 12:01:11 PM Central Daylight Time				06/28/2022 02:31:46 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Silver Community (HMO-POS)	01	02		1			H0332	007	0	2023	AU,CH,GM,LB,SJ,WA,WL, and WH counties		2		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	08/03/2022	2023.01	08/03/2022 11:07:55 AM Central Daylight Time	08/04/2022 10:55:14 AM Central Daylight Time	08/04/2022 10:55:14 AM Central Daylight Time			08/04/2022 11:07:58 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Gold Community (HMO-POS)	01	02		1			H0332	008	0	2023	AU,CH,GM,LB,SJ,WA,WL, and WH counties		2		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	08/03/2022	2023.01	08/03/2022 11:08:10 AM Central Daylight Time	08/04/2022 10:55:14 AM Central Daylight Time	08/04/2022 10:55:14 AM Central Daylight Time			08/04/2022 11:07:58 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Platinum (HMO)	01	01		1			H0332	009	0	2023	BO,FB,FV,HR, and MQ counties		2		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	4	1				0	0	05/18/2022	2023.01	05/18/2022 08:59:51 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	801	0	2023	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	4	1						05/05/2022	2023.01	05/05/2022 01:57:24 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	803	0	2023	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	4	1				0	0	05/05/2022	2023.01	05/05/2022 01:57:32 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	01	01		1			H0332	804	0	2023	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	4	1						05/05/2022	2023.01	05/05/2022 01:57:39 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	01	01		1			H0332	805	0	2023	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	4	1				0	0	05/05/2022	2023.01	05/05/2022 01:57:48 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	806	0	2023	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	4	1						05/05/2022	2023.01	05/05/2022 01:57:54 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	807	0	2023	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	4	1				0	0	05/05/2022	2023.01	05/05/2022 01:58:01 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	01	01		1			H0332	808	0	2023	Texas		1	6972	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	4	1						05/05/2022	2023.01	05/05/2022 01:58:08 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	01	01		1			H0332	809	0	2023	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	4	1						05/05/2022	2023.01	05/05/2022 01:58:16 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	810	0	2023	Texas		1	2127	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	4	1						05/05/2022	2023.01	05/05/2022 01:58:24 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	811	0	2023	Texas		1	75264	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	4	1						05/05/2022	2023.01	05/05/2022 01:58:32 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	812	0	2023	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	4	1						05/05/2022	2023.01	05/05/2022 01:58:40 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage RX Retiree (HMO)	01	01		1			H0332	813	0	2023	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	4	1				0	0	05/05/2022	2023.01	05/05/2022 01:58:47 PM Central Daylight Time					06/05/2022 09:57:17 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	814	0	2023	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	2	1						07/11/2022	2023.01	07/11/2022 10:53:43 AM Eastern Daylight Time					07/11/2022 11:14:10 AM 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	2023	Illinois		2	199947	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	6	1					1	08/04/2022	2023.01	08/04/2022 02:51:59 PM Eastern Daylight Time	08/03/2022 10:34:56 AM Eastern Daylight Time	08/02/2022 02:14:36 PM Eastern Daylight Time			08/05/2022 12:05:01 PM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CarePartners Access (PPO)	01	04		1			H0342	001	0	2023	Most of Connecticut		2		2			2									www.carepartnersct.com/carepartners-connecticut-doctor-search	www.carepartnersct.com/drug-search	www.carepartnersct.com/search-doctors	(866)632-0060		(866)632-0060		(844)402-6874		(844)402-6874		(866)632-0060		(866)632-0060		(844)402-6874		(844)402-6874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0342	801	0	1	04	01	H0342_801_0	3	1						09/28/2022	2023.01	09/28/2022 03:59:25 PM Eastern Daylight Time					09/29/2022 09:23:21 AM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CarePartners Access (PPO)	01	04		1			H0342	801	0	2023	Most of Connecticut		1	12	2			2									www.carepartnersct.com/carepartners-connecticut-doctor-search	www.carepartnersct.com/drug-search	www.carepartnersct.com/search-doctors	(866)632-0060		(866)632-0060		(844)402-6874		(844)402-6874		(866)632-0060		(866)632-0060		(844)402-6874		(844)402-6874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0342	802	0	1	04	01	H0342_802_0	3	1						09/28/2022	2023.01	09/28/2022 04:49:20 PM Eastern Daylight Time					09/29/2022 09:23:21 AM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CarePartners Access (PPO)	01	04		1			H0342	802	0	2023	Most of Connecticut		1	12	2			2									www.carepartnersct.com/carepartners-connecticut-doctor-search	www.carepartnersct.com/drug-search	www.carepartnersct.com/search-doctors	(866)632-0060		(866)632-0060		(844)402-6874		(844)402-6874		(866)632-0060		(866)632-0060		(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	5	1		1			1	08/03/2022	2023.01	08/03/2022 02:32:14 PM Eastern Daylight Time	08/03/2022 04:22:44 PM Pacific Daylight Time	07/30/2022 04:17:54 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific 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	2023	Select counties in AZ		2		2			1	4			00000000000000000010000					www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	053	0	1	01	01	H0351_053_0	4	1						08/03/2022	2023.01	08/03/2022 02:33:29 PM Eastern Daylight Time	08/03/2022 04:23:56 PM Pacific Daylight Time	07/30/2022 04:18:24 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare No Premium (HMO)	01	01		1			H0351	053	0	2023	Select counties in AZ		2		2			2									www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	054	0	1	01	01	H0351_054_0	5	1						07/21/2022	2023.01	07/21/2022 02:04:53 PM Eastern Daylight Time	08/03/2022 04:25:09 PM Pacific Daylight Time	07/30/2022 04:18:55 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Giveback (HMO)	01	01		1			H0351	054	0	2023	Select counties in AZ		2		2			2									www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	057	0	1	01	01	H0351_057_0	5	1		1			1	08/01/2022	2023.01	08/01/2022 03:26:55 PM Eastern Daylight Time	08/03/2022 04:26:21 PM Pacific Daylight Time	07/30/2022 04:19:26 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific 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	2023	Select counties in AZ		2		2			1	4			00000000000000000010000					www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	058	1	1	01	01	H0351_058_1	4	1						08/01/2022	2023.01	08/01/2022 03:29:14 PM Eastern Daylight Time	08/03/2022 04:27:32 PM Pacific Daylight Time	07/30/2022 04:19:57 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare No Premium (HMO)	01	01		1			H0351	058	1	2023	Select Counties in Arizona	Select Counties in Arizona	2		2			2									allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	058	2	1	01	01	H0351_058_2	4	1						08/01/2022	2023.01	08/01/2022 03:32:24 PM Eastern Daylight Time	08/03/2022 04:28:44 PM Pacific Daylight Time	07/30/2022 04:20:28 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare No Premium (HMO)	01	01		1			H0351	058	2	2023	Select Counties in Arizona	Select Counties in Arizona	2		2			2									allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	059	1	1	01	01	H0351_059_1	4	1						06/02/2022	2023.01	06/02/2022 04:38:42 PM Eastern Daylight Time	08/03/2022 04:29:55 PM Pacific Daylight Time	07/30/2022 04:21:00 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Assist (HMO)	01	01		1			H0351	059	1	2023	Select Counties in Arizona	Select Counties in Arizona	2		2			2									allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	059	2	1	01	01	H0351_059_2	4	1						05/26/2022	2023.01	05/26/2022 10:19:09 AM Eastern Daylight Time	08/03/2022 04:31:03 PM Pacific Daylight Time	07/30/2022 04:21:32 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Assist (HMO)	01	01		1			H0351	059	2	2023	Select Counties in Arizona	Select Counties in Arizona	2		2			2									allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	060	1	1	01	01	H0351_060_1	4	1						05/26/2022	2023.01	05/26/2022 10:20:20 AM Eastern Daylight Time	08/03/2022 04:32:13 PM Pacific Daylight Time	07/30/2022 04:22:02 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Giveback (HMO)	01	01		1			H0351	060	1	2023	Select Counties in Arizona	Select Counties in Arizona	2		2			2									allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	060	2	1	01	01	H0351_060_2	5	1						05/26/2022	2023.01	05/26/2022 10:21:30 AM Eastern Daylight Time	08/03/2022 04:33:26 PM Pacific Daylight Time	07/30/2022 04:22:33 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Giveback (HMO)	01	01		1			H0351	060	2	2023	Select Counties in Arizona	Select Counties in Arizona	2		2			2									allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	061	0	1	01	01	H0351_061_0	5	1						05/26/2022	2023.01	05/26/2022 10:22:37 AM Eastern Daylight Time	08/03/2022 04:34:39 PM Pacific Daylight Time	07/30/2022 04:23:05 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Assist (HMO)	01	01		1			H0351	061	0	2023	Select Counties in Arizona		2		2			2									allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	801	0	1	01	01	H0351_801_0	1	1						05/10/2022	2023.01	05/10/2022 09:37:31 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	allwell.azcompletehealth.com	Allwell CoCare (HMO)	01	01		1			H0351	801	0	2023	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)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:38:06 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	allwell.azcompletehealth.com	Allwell CoCare (HMO)	01	01		1			H0351	803	0	2023	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)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 09:38:32 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	allwell.azcompletehealth.com	Allwell CoCare (HMO)	01	01		1			H0351	804	0	2023	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)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	4	1					1	08/02/2022	2023.01	08/02/2022 04:36:21 PM Central Daylight Time	08/01/2022 04:52:26 PM Central Daylight Time	08/01/2022 10:10:11 AM Central Daylight Time			08/04/2022 01:36:02 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0354	001	0	2023	Central Arizona		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	4	1		1				08/02/2022	2023.01	08/02/2022 04:37:09 PM Central Daylight Time	08/02/2022 01:58:37 PM Central Daylight Time	08/01/2022 10:10:42 AM Central Daylight Time			08/04/2022 01:36:02 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Achieve Medicare (HMO C-SNP)	01	01		1			H0354	027	0	2023	Central Arizona		2		2			1	4			00000010000000000000000					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	4	1					1	08/02/2022	2023.01	08/02/2022 04:37:47 PM Central Daylight Time	08/01/2022 04:53:40 PM Central Daylight Time	08/01/2022 10:11:13 AM Central Daylight Time			08/04/2022 01:36:02 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Alliance Medicare (HMO)	01	01		1			H0354	028	0	2023	Central Arizona		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	029	0	1	01	01	H0354_029_0	4	1					1	08/02/2022	2023.01	08/02/2022 04:38:08 PM Central Daylight Time	08/01/2022 04:54:35 PM Central Daylight Time	08/01/2022 10:11:44 AM Central Daylight Time			08/04/2022 01:36:02 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H0354	029	0	2023	Central Arizona		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)627-7534		(800)627-7534		(800)627-7534		(800)627-7534		(800)627-7534		(800)627-7534		(800)627-7534		(800)627-7534		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	804	0	1	01	01	H0354_804_0	2	1						05/22/2022	2023.01	05/22/2022 05:12:07 PM Central Daylight Time					06/02/2022 11:39:04 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0354	804	0	2023	Statewide AZ		1	5148	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	2	1						05/22/2022	2023.01	05/22/2022 05:13:00 PM Central Daylight Time					06/02/2022 11:39:04 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare FY (HMO)	01	01		1			H0354	805	0	2023	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	10	1		1				08/03/2022	2023.01	08/03/2022 04:56:57 PM Central Daylight Time	08/04/2022 12:16:40 PM Central Daylight Time	08/02/2022 08:32:17 AM Central Daylight Time			08/04/2022 03:18:36 PM Central 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	2023	CO (Partial)		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			
H0363	003	0	1	01	01	H0363_003_0	11	1		1			1	08/04/2022	2023.01	08/04/2022 03:02:38 PM Central Daylight Time	08/04/2022 12:18:26 PM Central Daylight Time	08/02/2022 08:36:11 AM Central Daylight Time			08/04/2022 03:18:36 PM Central Daylight Time	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan Assisted Living (HMO I-SNP)	01	01		1			H0363	003	0	2023	CO (Partial)		2		2			1	1	2							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						06/06/2022	2023.01	06/06/2022 10:21:34 AM Eastern Daylight Time		06/06/2022 10:08:37 AM Eastern Daylight Time			06/06/2022 10:22:44 AM Eastern Daylight Time	PACE OF SOUTHWEST MICHIGAN, INC.	PACE of Southwest Michigan	http://www.paceswmi.org/	PACE of Southwest Michigan - Dual (PACE)	08	20		1			H0390	001	0	2023	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						06/06/2022	2023.01	06/06/2022 10:21:53 AM Eastern Daylight Time		06/06/2022 10:08:37 AM Eastern Daylight Time			06/06/2022 10:22:44 AM Eastern Daylight Time	PACE OF SOUTHWEST MICHIGAN, INC.	PACE of Southwest Michigan	http://www.paceswmi.org/	PACE of Southwest Michigan - Medicare Only (PACE)	08	20		1			H0390	002	0	2023	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	6	1					1	09/14/2022	2023.01	09/14/2022 01:42:14 PM Central Daylight Time	08/03/2022 11:10:14 AM Central Daylight Time	08/01/2022 03:23:59 PM Central Daylight Time			09/15/2022 02:07:40 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	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 12:24:51 PM Central Daylight Time	08/03/2022 11:07:56 AM Central Daylight Time	08/01/2022 03:44:38 PM Central Daylight Time			08/05/2022 02:16:00 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	2023	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	6	1	2	1	1		0	07/01/2022	2023.01	07/01/2022 03:23:16 PM Eastern Daylight Time	08/03/2022 09:42:29 AM Eastern Daylight Time	08/03/2022 09:42:30 AM Eastern Daylight Time			08/03/2022 09:48:26 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	2023	NYC - All five boroughs		2		2			1	3		1					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)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0423	004	0	1	01	01	H0423_004_0	5	1			2			06/03/2022	2023.01	06/03/2022 12:09:43 PM Eastern Daylight Time	08/03/2022 09:42:34 AM Eastern Daylight Time	08/03/2022 09:42:37 AM Eastern Daylight Time			08/03/2022 09:48:26 AM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Platinum Plan (HMO)	01	01		1			H0423	004	0	2023	NYC - All five boroughs		2		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)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0423	007	0	1	01	01	H0423_007_0	7	1	2	1	2		0	07/01/2022	2023.01	07/01/2022 03:24:12 PM Eastern Daylight Time	08/03/2022 09:42:40 AM Eastern Daylight Time	08/03/2022 09:42:41 AM Eastern Daylight Time			08/03/2022 09:48:26 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	2023	NYC - All five boroughs		2		2			1	3		1					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)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	003	0	1	02	01	H0432_003_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 03:22:50 PM Central Daylight Time	08/03/2022 10:40:37 AM Central Daylight Time	07/30/2022 11:29:41 PM Central Daylight Time			08/04/2022 03:32:48 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H0432	003	0	2023	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	02	01	H0432_004_0	2	1			1		1	08/02/2022	2023.01	08/02/2022 03:23:19 PM Central Daylight Time	08/03/2022 10:41:08 AM Central Daylight Time	07/30/2022 11:30:05 PM Central Daylight Time			08/04/2022 03:32:48 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H0432	004	0	2023	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	02	01	H0432_009_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 03:26:27 PM Central Daylight Time	08/03/2022 10:41:39 AM Central Daylight Time	07/30/2022 11:30:29 PM Central Daylight Time			08/04/2022 03:32:48 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H0432	009	0	2023	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	02	01	H0432_010_0	2	1			1		1	08/02/2022	2023.01	08/02/2022 03:27:52 PM Central Daylight Time	08/03/2022 10:42:09 AM Central Daylight Time	07/30/2022 11:30:53 PM Central Daylight Time			08/04/2022 03:32:48 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO-POS)	01	02		1			H0432	010	0	2023	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	02	01	H0432_012_0	1	1			1	0	0	05/31/2022	2023.01	05/31/2022 12:30:55 PM Central Daylight Time	06/01/2022 11:45:20 AM Central Daylight Time				06/03/2022 09:54:13 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H0432	012	0	2023	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	02	01	H0432_013_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 03:30:57 PM Central Daylight Time	08/03/2022 10:42:41 AM Central Daylight Time	07/30/2022 11:31:17 PM Central Daylight Time			08/04/2022 03:32:48 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H0432	013	0	2023	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	1		0	05/31/2022	2023.01	05/31/2022 10:57:48 AM Central Daylight Time	08/02/2022 03:52:22 PM Central Daylight Time	08/01/2022 10:12:16 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H0439	002	0	2023	Georgia		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	003	1	1	01	01	H0439_003_1	4	1			2		1	08/02/2022	2023.01	08/02/2022 05:13:41 PM Central Daylight Time	08/02/2022 09:42:16 PM Central Daylight Time	08/01/2022 10:12:47 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred GA Medicare (HMO)	01	01		1			H0439	003	1	2023	Georgia	GA Metro/West Metro/Athens	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	003	2	1	01	01	H0439_003_2	4	1			2		1	08/02/2022	2023.01	08/02/2022 05:14:20 PM Central Daylight Time	08/02/2022 03:54:49 PM Central Daylight Time	08/01/2022 10:13:19 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred GA Medicare (HMO)	01	01		1			H0439	003	2	2023	Georgia	GA NE/NW Metro/West Metro	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	006	0	1	01	01	H0439_006_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 05:15:41 PM Central Daylight Time	08/02/2022 03:55:29 PM Central Daylight Time	08/01/2022 10:13:50 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H0439	006	0	2023	Georgia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	007	0	1	01	01	H0439_007_0	4	1			2		1	08/03/2022	2023.01	08/03/2022 09:23:43 AM Central Daylight Time	08/03/2022 09:41:11 AM Central Daylight Time	08/01/2022 10:14:21 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	007	0	2023	Metro Georgia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	008	0	1	01	01	H0439_008_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 05:18:05 PM Central Daylight Time	08/02/2022 03:57:23 PM Central Daylight Time	08/01/2022 10:14:52 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	008	0	2023	West Metro Georgia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	009	0	1	01	01	H0439_009_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 05:18:58 PM Central Daylight Time	08/02/2022 09:44:39 PM Central Daylight Time	08/01/2022 10:15:23 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	009	0	2023	Athens		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	010	0	1	01	01	H0439_010_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 05:19:55 PM Central Daylight Time	08/02/2022 03:58:43 PM Central Daylight Time	08/01/2022 10:15:53 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	010	0	2023	Northeast Georgia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	011	0	1	01	01	H0439_011_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 05:20:30 PM Central Daylight Time	08/02/2022 03:59:21 PM Central Daylight Time	08/01/2022 10:16:24 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	011	0	2023	Northwest Georgia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	012	0	1	01	01	H0439_012_0	4	1	2	1	1		0	05/28/2022	2023.01	05/28/2022 01:20:31 PM Central Daylight Time	08/02/2022 04:00:06 PM Central Daylight Time	08/01/2022 10:16:57 AM Central Daylight Time			08/04/2022 01:44:57 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	2023	Georgia		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	013	0	1	01	01	H0439_013_0	4	1			2		1	08/03/2022	2023.01	08/03/2022 10:17:22 AM Central Daylight Time	08/03/2022 09:36:51 AM Central Daylight Time	08/01/2022 10:17:28 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	013	0	2023	Savannah		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	801	0	1	01	01	H0439_801_0	2	1						05/22/2022	2023.01	05/22/2022 05:19:00 PM Central Daylight Time					06/02/2022 07:50:30 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	801	0	2023	Statewide GA		1	600	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				
H0440	001	0	1	20	08	H0440_001_0	1	1						10/24/2022	2023.01	10/24/2022 10:28:17 AM Eastern Daylight Time		10/18/2022 01:32:30 PM Eastern Daylight Time			10/24/2022 10:29:44 AM Eastern Daylight Time	EMPATH LIFE, LLC	Empath LIFE	EmpathHealth.org	Empath LIFE, LLC (PACE)	08	20		1			H0440	001	0	2023	Empath LIFE Inc. - Hillsborough County		2		2			2									empathhealth.org	empathhealth.org												(727)289-0062				(727)289-0062												(727)289-0062				(727)289-0062																
H0440	002	0	1	20	08	H0440_002_0	1	1						10/24/2022	2023.01	10/24/2022 10:28:29 AM Eastern Daylight Time		10/18/2022 01:32:30 PM Eastern Daylight Time			10/24/2022 10:29:44 AM Eastern Daylight Time	EMPATH LIFE, LLC	Empath LIFE	EmpathHealth.org	Empath LIFE, LLC (PACE)	08	20		1			H0440	002	0	2023	Empath LIFE Inc. - Hillsborough County		2		2			2									empathhealth.org	empathhealth.org												(727)289-0062				(727)289-0062												(727)289-0062				(727)289-0062																
H0473	001	0	1	04	01	H0473_001_0	4	1			2		1	08/01/2022	2023.01	08/01/2022 04:29:54 PM Eastern Daylight Time	08/03/2022 03:47:11 PM Eastern Daylight Time	07/30/2022 05:21:16 AM Eastern Daylight Time			08/04/2022 12:58:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-001 (PPO)	01	04		1			H0473	001	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			2		1	05/28/2022	2023.01	05/28/2022 01:17:11 PM Eastern Daylight Time	08/03/2022 03:50:07 PM Eastern Daylight Time	07/30/2022 05:21:40 AM Eastern Daylight Time			08/04/2022 01:29:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-003 (PPO)	01	04		1			H0473	003	0	2023	Hays, Travis and Williamson counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:57:43 PM Eastern Daylight Time	08/03/2022 03:50:59 PM Eastern Daylight Time	07/30/2022 05:22:04 AM Eastern Daylight Time			08/04/2022 12:58:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-004 (PPO)	01	04		1			H0473	004	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:58:33 PM Eastern Daylight Time	08/03/2022 03:51:24 PM Eastern Daylight Time	07/30/2022 05:22:30 AM Eastern Daylight Time			08/04/2022 12:58:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-005 (PPO)	01	04		1			H0473	005	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	08/02/2022	2023.01	08/02/2022 12:48:41 PM Eastern Daylight Time	08/03/2022 03:50:33 PM Eastern Daylight Time	07/30/2022 05:22:54 AM Eastern Daylight Time			08/04/2022 12:58:32 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	2023	Select Counties in Texas		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						06/03/2022	2023.01	06/03/2022 01:04:18 PM Eastern Daylight Time		06/03/2022 01:00:00 PM Eastern Daylight Time			06/03/2022 01:06:26 PM Eastern Daylight Time	SERENITY CARE, INC.	Serenity Care PACE	http://www.serenitypace.org	Serenity PACE Dual (PACE)	08	20		1			H0477	001	0	2023	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						06/03/2022	2023.01	06/03/2022 01:04:41 PM Eastern Daylight Time		06/03/2022 01:00:00 PM Eastern Daylight Time			06/03/2022 01:06:26 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	2023	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	7	1						05/26/2023	2023.01	05/26/2023 09:34:46 AM Eastern Daylight Time					05/26/2023 06:25:02 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianComplete (Medicare-Medicaid Plan)	https://corp.mhplan.com/	MeridianComplete (Medicare-Medicaid Plan)	05	48		1			H0480	001	0	2023	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		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0482	001	0	1	01	01	H0482_001_0	5	1						08/01/2022	2023.01	08/01/2022 12:32:16 PM Central Daylight Time	08/03/2022 08:22:27 PM Eastern Daylight Time	07/30/2022 07:23:36 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan Reward (HMO)	01	01		1			H0482	001	0	2023	Select counties in Michigan		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	002	0	1	01	01	H0482_002_0	5	1						08/04/2022	2023.01	08/04/2022 10:29:46 AM Central Daylight Time	08/03/2022 08:23:41 PM Eastern Daylight Time	07/30/2022 07:24:07 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan Secure (HMO)	01	01		1			H0482	002	0	2023	Select counties in Michigan		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	003	0	1	01	01	H0482_003_0	5	1						08/01/2022	2023.01	08/01/2022 12:34:16 PM Central Daylight Time	08/03/2022 08:24:55 PM Eastern Daylight Time	07/30/2022 07:24:38 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan Reward (HMO)	01	01		1			H0482	003	0	2023	Detroit Area		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	004	0	1	01	01	H0482_004_0	5	1						08/01/2022	2023.01	08/01/2022 12:35:47 PM Central Daylight Time	08/03/2022 08:26:09 PM Eastern Daylight Time	07/30/2022 07:25:09 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan Secure (HMO)	01	01		1			H0482	004	0	2023	Detroit Area		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	005	0	1	01	01	H0482_005_0	5	1	2	1			0	07/15/2022	2023.01	07/15/2022 08:21:12 AM Central Daylight Time	08/03/2022 08:27:32 PM Eastern Daylight Time	07/30/2022 07:25:40 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan DSNP (HMO D-SNP)	01	01		1			H0482	005	0	2023	Select counties in Michigan		2		2			1	3		1					1	www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	006	0	1	01	01	H0482_006_0	6	1	2	1			0	07/15/2022	2023.01	07/15/2022 08:25:46 AM Central Daylight Time	08/03/2022 08:28:47 PM Eastern Daylight Time	07/30/2022 07:26:11 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan DSNP (HMO D-SNP)	01	01		1			H0482	006	0	2023	Lapeer, Livingston,Macomb,Oakland,St.Clair,Wayne		2		2			1	3		1					1	www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	801	0	1	01	01	H0482_801_0	1	1						05/10/2022	2023.01	05/10/2022 09:39:06 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H0482	801	0	2023	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	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:39:31 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H0482	802	0	2023	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	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 09:39:58 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H0482	803	0	2023	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	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	5	1					0	08/04/2022	2023.01	08/04/2022 02:05:53 PM Pacific Daylight Time	08/03/2022 04:38:05 PM Pacific Daylight Time	08/02/2022 04:52:51 PM Pacific Daylight Time			08/05/2022 08:52:47 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	015	0	2023	Los Angeles and Orange Counties		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	08/04/2022	2023.01	08/04/2022 02:08:17 PM Pacific Daylight Time	08/03/2022 08:09:04 PM Pacific Daylight Time	08/02/2022 04:53:50 PM Pacific Daylight Time			08/05/2022 08:52:47 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	017	0	2023	San Bernardino County		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	5	1						08/04/2022	2023.01	08/04/2022 02:09:45 PM Pacific Daylight Time	08/03/2022 04:38:47 PM Pacific Daylight Time	08/02/2022 04:54:56 PM Pacific Daylight Time			08/05/2022 08:52:47 AM 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	2023	Los Angeles and Orange Counties		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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						08/04/2022	2023.01	08/04/2022 02:11:07 PM Pacific Daylight Time	08/03/2022 04:39:12 PM Pacific Daylight Time	08/02/2022 04:56:07 PM Pacific Daylight Time			08/05/2022 08:52:47 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	026	0	2023	Riverside County		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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					1	08/04/2022	2023.01	08/04/2022 02:12:11 PM Pacific Daylight Time	08/03/2022 04:39:37 PM Pacific Daylight Time	08/02/2022 04:57:08 PM Pacific Daylight Time			08/05/2022 08:52:47 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	028	0	2023	San Diego County		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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					1	08/04/2022	2023.01	08/04/2022 02:14:12 PM Pacific Daylight Time	08/03/2022 08:30:37 PM Pacific Daylight Time	08/02/2022 04:58:04 PM Pacific Daylight Time			08/05/2022 08:55:32 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	029	0	2023	Ventura County		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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					1	07/18/2022	2023.01	07/18/2022 02:07:55 PM Pacific Daylight Time	08/03/2022 08:34:35 PM Pacific Daylight Time	08/03/2022 03:47:29 PM Pacific Daylight Time			08/05/2022 08:55:32 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	037	0	2023	Sacramento County		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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					1	08/04/2022	2023.01	08/04/2022 02:17:22 PM Pacific Daylight Time	08/03/2022 08:38:27 PM Pacific Daylight Time	08/02/2022 05:00:15 PM Pacific Daylight Time			08/05/2022 08:55:32 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	038	0	2023	Kern County		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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					1	08/04/2022	2023.01	08/04/2022 02:19:39 PM Pacific Daylight Time	08/03/2022 04:40:54 PM Pacific Daylight Time	08/02/2022 05:52:03 PM Pacific Daylight Time			08/05/2022 08:55:32 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	039	0	2023	San Luis Obispo and Santa Barbara Counties		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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					1	08/04/2022	2023.01	08/04/2022 02:20:59 PM Pacific Daylight Time	08/03/2022 04:41:20 PM Pacific Daylight Time	08/02/2022 05:02:05 PM Pacific Daylight Time			08/05/2022 08:55:32 AM 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	2023	Riverside and San Bernardino Counties		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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					1	08/04/2022	2023.01	08/04/2022 02:22:29 PM Pacific Daylight Time	08/03/2022 04:41:45 PM Pacific Daylight Time	08/02/2022 05:03:27 PM Pacific Daylight Time			08/05/2022 08:57:52 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	041	0	2023	Alameda and San Mateo Counties		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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					1	08/04/2022	2023.01	08/04/2022 02:23:38 PM Pacific Daylight Time	08/03/2022 04:42:10 PM Pacific Daylight Time	08/02/2022 05:04:44 PM Pacific Daylight Time			08/05/2022 08:57:52 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	043	0	2023	Los Angeles and Orange Counties		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	5	1					1	08/04/2022	2023.01	08/04/2022 02:25:30 PM Pacific Daylight Time	08/03/2022 08:48:46 PM Pacific Daylight Time	08/02/2022 05:06:05 PM Pacific Daylight Time			08/05/2022 08:57:52 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	047	0	2023	Counties: MER, SJ, STAN, FR, MAD, SC		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	5	1					1	08/04/2022	2023.01	08/04/2022 02:26:53 PM Pacific Daylight Time	08/03/2022 04:42:52 PM Pacific Daylight Time	08/02/2022 05:07:22 PM Pacific Daylight Time			08/05/2022 08:57:52 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Balance (HMO)	01	01		1			H0504	048	0	2023	Los Angeles County		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	049	0	1	01	01	H0504_049_0	5	1					1	08/04/2022	2023.01	08/04/2022 02:28:09 PM Pacific Daylight Time	08/04/2022 10:35:21 AM Pacific Daylight Time	08/02/2022 05:13:18 PM Pacific Daylight Time			08/05/2022 08:57:52 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Enhanced (HMO)	01	01		1			H0504	049	0	2023	Los Angeles and Orange Counties		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	803	0	1	01	01	H0504_803_0	3	1						05/20/2022	2023.01	05/20/2022 10:59:02 AM Pacific Daylight Time					06/03/2022 02:25:24 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	803	0	2023	MA-PD Employer Group Plan		1	15517	2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	3	1						05/20/2022	2023.01	05/20/2022 10:59:22 AM Pacific Daylight Time					06/03/2022 02:26:47 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	804	0	2023	MA-PD Employer Group Plan		1	3482	2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	3	1				0	0	05/20/2022	2023.01	05/20/2022 10:59:37 AM Pacific Daylight Time					06/03/2022 02:26:47 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus without Rx (HMO)	01	01		1			H0504	805	0	2023	MA-Only Employer Group Plan		1	0	2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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;7i;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	3	1				0	0	05/20/2022	2023.01	05/20/2022 10:59:49 AM Pacific Daylight Time					06/03/2022 02:26:47 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus without Rx (HMO)	01	01		1			H0504	806	0	2023	MA-only Employer Group Plan		1	0	2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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;7i;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	5	1						08/02/2022	2023.01	08/02/2022 01:50:18 PM Eastern Daylight Time	08/02/2022 03:18:15 PM Eastern Daylight Time	07/31/2022 08:45:28 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1						08/02/2022	2023.01	08/02/2022 01:50:31 PM Eastern Daylight Time	08/02/2022 03:19:11 PM Eastern Daylight Time	07/31/2022 08:45:54 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1						08/02/2022	2023.01	08/02/2022 01:50:44 PM Eastern Daylight Time	08/02/2022 03:20:07 PM Eastern Daylight Time	07/31/2022 08:46:20 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1						08/02/2022	2023.01	08/02/2022 01:50:58 PM Eastern Daylight Time	08/02/2022 03:21:02 PM Eastern Daylight Time	07/31/2022 08:46:44 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1						08/02/2022	2023.01	08/02/2022 01:51:14 PM Eastern Daylight Time	08/02/2022 03:21:58 PM Eastern Daylight Time	07/31/2022 08:47:08 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	065	0	1	01	01	H0523_065_0	6	1						08/02/2022	2023.01	08/02/2022 01:51:29 PM Eastern Daylight Time	08/02/2022 03:22:53 PM Eastern Daylight Time	07/31/2022 08:47:34 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	065	0	2023	Sacramento 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	066	0	1	01	01	H0523_066_0	5	1						08/02/2022	2023.01	08/02/2022 01:51:46 PM Eastern Daylight Time	08/02/2022 03:23:49 PM Eastern Daylight Time	07/31/2022 08:47:58 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	066	0	2023	Yolo 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	067	0	1	01	01	H0523_067_0	5	1						08/02/2022	2023.01	08/02/2022 01:52:02 PM Eastern Daylight Time	08/02/2022 03:24:44 PM Eastern Daylight Time	07/31/2022 08:48:22 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	067	0	2023	San Joaquin 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	068	0	1	01	01	H0523_068_0	5	1						08/02/2022	2023.01	08/02/2022 01:52:17 PM Eastern Daylight Time	08/02/2022 03:25:40 PM Eastern Daylight Time	07/31/2022 08:48:48 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	068	0	2023	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			
H0523	069	0	1	01	01	H0523_069_0	5	1						08/02/2022	2023.01	08/02/2022 01:52:33 PM Eastern Daylight Time	08/02/2022 03:26:35 PM Eastern Daylight Time	07/31/2022 08:49:14 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	069	0	2023	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			
H0523	070	0	1	01	01	H0523_070_0	5	1						08/02/2022	2023.01	08/02/2022 01:52:47 PM Eastern Daylight Time	08/02/2022 03:27:31 PM Eastern Daylight Time	07/31/2022 08:49:38 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	070	0	2023	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			
H0523	071	0	1	01	01	H0523_071_0	5	1						08/02/2022	2023.01	08/02/2022 01:53:02 PM Eastern Daylight Time	08/02/2022 03:28:26 PM Eastern Daylight Time	07/31/2022 08:50:04 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	071	0	2023	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			
H0523	072	0	1	01	01	H0523_072_0	5	1						08/02/2022	2023.01	08/02/2022 01:53:18 PM Eastern Daylight Time	08/02/2022 03:29:22 PM Eastern Daylight Time	07/31/2022 08:50:30 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	072	0	2023	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			
H0523	073	0	1	01	01	H0523_073_0	5	1						08/02/2022	2023.01	08/02/2022 01:53:33 PM Eastern Daylight Time	08/02/2022 03:30:19 PM Eastern Daylight Time	07/31/2022 08:50:54 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime II Plan (HMO)	01	01		1			H0523	073	0	2023	Orange 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	801	0	1	01	01	H0523_801_0	1	1				0	0	05/26/2022	2023.01	05/26/2022 01:15:49 PM Eastern Daylight Time					06/02/2022 02:29:54 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H0523	801	0	2023	California		1	5510	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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						05/26/2022	2023.01	05/26/2022 01:48:50 PM Eastern Daylight Time					06/02/2022 02:34:09 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	2023	California		1	5040	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;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				
H0524	003	0	1	01	01	H0524_003_0	9	1			2			08/02/2022	2023.01	08/02/2022 11:04:55 AM Pacific Daylight Time	08/03/2022 02:25:14 PM Pacific Daylight Time	08/03/2022 12:19:13 PM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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			08/03/2022	2023.01	08/03/2022 03:42:06 PM Pacific Daylight Time	08/04/2022 08:17:58 AM Pacific Daylight Time	08/04/2022 08:32:06 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	013	0	1	01	01	H0524_013_0	9	1			2			08/02/2022	2023.01	08/02/2022 01:22:25 PM Pacific Daylight Time	08/04/2022 08:18:21 AM Pacific Daylight Time	08/04/2022 08:32:49 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 11:11:50 AM Pacific Daylight Time	08/03/2022 02:25:46 PM Pacific Daylight Time	08/03/2022 12:20:20 PM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	8	1	2	1	2		0	08/02/2022	2023.01	08/02/2022 10:57:46 AM Pacific Daylight Time	08/04/2022 08:26:34 AM Pacific Daylight Time	08/04/2022 08:47:51 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 12:03:28 PM Pacific Daylight Time	08/04/2022 08:18:45 AM Pacific Daylight Time	08/04/2022 08:33:32 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 12:35:25 PM Pacific Daylight Time	08/04/2022 08:19:08 AM Pacific Daylight Time	08/04/2022 08:34:16 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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			08/02/2022	2023.01	08/02/2022 12:56:00 PM Pacific Daylight Time	08/04/2022 08:19:32 AM Pacific Daylight Time	08/04/2022 08:35:00 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			1			08/02/2022	2023.01	08/02/2022 12:17:44 PM Pacific Daylight Time	08/03/2022 02:26:18 PM Pacific Daylight Time	08/03/2022 12:21:26 PM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 11:13:44 AM Pacific Daylight Time	08/03/2022 02:26:51 PM Pacific Daylight Time	08/03/2022 12:22:33 PM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 11:14:43 AM Pacific Daylight Time	08/03/2022 02:27:23 PM Pacific Daylight Time	08/03/2022 12:23:36 PM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 03:59:34 PM Pacific Daylight Time	08/03/2022 02:27:55 PM Pacific Daylight Time	08/03/2022 12:24:41 PM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 04:14:09 PM Pacific Daylight Time	08/04/2022 08:19:56 AM Pacific Daylight Time	08/04/2022 08:35:43 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 01:05:02 PM Pacific Daylight Time	08/04/2022 08:20:20 AM Pacific Daylight Time	08/04/2022 08:36:28 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 04:14:53 PM Pacific Daylight Time	08/04/2022 08:20:44 AM Pacific Daylight Time	08/04/2022 08:37:13 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 01:50:47 PM Pacific Daylight Time	08/04/2022 08:21:08 AM Pacific Daylight Time	08/04/2022 08:37:58 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 04:15:56 PM Pacific Daylight Time	08/04/2022 08:21:32 AM Pacific Daylight Time	08/04/2022 08:38:42 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 01:57:09 PM Pacific Daylight Time	08/04/2022 08:21:57 AM Pacific Daylight Time	08/04/2022 08:39:26 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 01:40:44 PM Pacific Daylight Time	08/04/2022 08:22:21 AM Pacific Daylight Time	08/04/2022 08:40:11 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 01:28:41 PM Pacific Daylight Time	08/04/2022 08:22:46 AM Pacific Daylight Time	08/04/2022 08:40:55 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 01:17:53 PM Pacific Daylight Time	08/04/2022 08:23:11 AM Pacific Daylight Time	08/04/2022 08:41:40 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 12:47:09 PM Pacific Daylight Time	08/04/2022 08:23:36 AM Pacific Daylight Time	08/04/2022 08:42:25 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 12:52:37 PM Pacific Daylight Time	08/04/2022 08:24:01 AM Pacific Daylight Time	08/04/2022 08:43:14 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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			08/03/2022	2023.01	08/03/2022 01:37:35 PM Pacific Daylight Time	08/04/2022 08:24:26 AM Pacific Daylight Time	08/04/2022 08:44:00 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 01:12:23 PM Pacific Daylight Time	08/04/2022 08:24:52 AM Pacific Daylight Time	08/04/2022 08:44:46 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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			08/02/2022	2023.01	08/02/2022 11:57:56 AM Pacific Daylight Time	08/04/2022 08:25:17 AM Pacific Daylight Time	08/04/2022 08:45:32 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 12:12:32 PM Pacific Daylight Time	08/04/2022 08:25:42 AM Pacific Daylight Time	08/04/2022 08:46:18 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	9	1			2			08/02/2022	2023.01	08/02/2022 04:44:00 PM Pacific Daylight Time	08/04/2022 08:26:08 AM Pacific Daylight Time	08/04/2022 08:47:04 AM Pacific Daylight Time			08/04/2022 02:25:31 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	2023	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	070	0	1	01	01	H0524_070_0	8	1	2	1	2		0	06/01/2022	2023.01	06/01/2022 04:05:04 PM Pacific Daylight Time	08/04/2022 08:26:59 AM Pacific Daylight Time	08/04/2022 08:48:39 AM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Los Angeles (HMO D-SNP)	01	01		1			H0524	070	0	2023	Medicare Medi-Cal Los Angeles County 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	071	0	1	01	01	H0524_071_0	8	1	2	1	2		0	06/02/2022	2023.01	06/02/2022 10:26:33 AM Pacific Daylight Time	08/04/2022 08:27:25 AM Pacific Daylight Time	08/04/2022 08:49:26 AM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal San Diego (HMO D-SNP)	01	01		1			H0524	071	0	2023	Medicare Medi-Cal San Diego County 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	072	0	1	01	01	H0524_072_0	8	1	2	1	2		0	06/02/2022	2023.01	06/02/2022 10:28:00 AM Pacific Daylight Time	08/04/2022 08:27:52 AM Pacific Daylight Time	08/04/2022 08:50:16 AM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Orange (HMO D-SNP)	01	01		1			H0524	072	0	2023	Medicare Medi-Cal Orange County 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	073	0	1	01	01	H0524_073_0	8	1	2	1	2		0	06/02/2022	2023.01	06/02/2022 10:28:57 AM Pacific Daylight Time	08/04/2022 08:28:20 AM Pacific Daylight Time	08/04/2022 08:51:07 AM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Inland Empire (HMO D-SNP)	01	01		1			H0524	073	0	2023	Medicare Medi-Cal Inland Empire 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	074	0	1	01	01	H0524_074_0	8	1	2	1	2		0	05/26/2022	2023.01	05/26/2022 08:57:11 AM Pacific Daylight Time	08/04/2022 08:28:47 AM Pacific Daylight Time	08/04/2022 08:51:59 AM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Santa Clara (HMO D-SNP)	01	01		1			H0524	074	0	2023	Medicare Medi-Cal Santa Clara 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	075	0	1	01	01	H0524_075_0	8	1	2	1	2		0	05/26/2022	2023.01	05/26/2022 08:57:23 AM Pacific Daylight Time	08/04/2022 08:29:15 AM Pacific Daylight Time	08/04/2022 08:52:48 AM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal San Mateo (HMO D-SNP)	01	01		1			H0524	075	0	2023	Medicare Medi-Cal San Mateo 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	078	0	1	01	01	H0524_078_0	9	1			2			08/02/2022	2023.01	08/02/2022 11:11:00 AM Pacific Daylight Time	08/03/2022 02:28:28 PM Pacific Daylight Time	08/03/2022 12:25:47 PM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Advantage LA, Orange Value (HMO)	01	01		1			H0524	078	0	2023	Los Angeles and Orange Counties Value 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	081	0	1	01	01	H0524_081_0	9	1			2			08/02/2022	2023.01	08/02/2022 11:12:42 AM Pacific Daylight Time	08/03/2022 02:29:01 PM Pacific Daylight Time	08/03/2022 12:26:51 PM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Advantage Inland Empire Value (HMO)	01	01		1			H0524	081	0	2023	Inland Empire Value 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	082	0	1	01	01	H0524_082_0	9	1			2			08/03/2022	2023.01	08/03/2022 12:21:56 PM Pacific Daylight Time	08/03/2022 02:29:35 PM Pacific Daylight Time	08/03/2022 12:27:55 PM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage San Diego Value (HMO)	01	01		1			H0524	082	0	2023	San Diego County Value 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	083	0	1	01	01	H0524_083_0	8	1			1			08/03/2022	2023.01	08/03/2022 12:21:41 PM Pacific Daylight Time	08/03/2022 02:30:08 PM Pacific Daylight Time	08/03/2022 12:29:02 PM Pacific Daylight Time			08/04/2022 02:25:31 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Ventura Value (HMO)	01	01		1			H0524	083	0	2023	Ventura County Value Plan		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	801	0	1	01	01	H0524_801_0	1	1				0	0	05/04/2022	2023.01	05/04/2022 04:37:23 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	801	0	2023	Southern California Group Part A B		1	27912	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	1	1				0	0	05/04/2022	2023.01	05/04/2022 04:37:36 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	802	0	2023	Northern California Group Part A B		1	115713	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	1	1				0	0	05/04/2022	2023.01	05/04/2022 04:37:47 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	803	0	2023	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	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	1	1				0	0	05/04/2022	2023.01	05/04/2022 04:37:59 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	804	0	2023	Northern California Group B Only		1	120	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	1	1						05/04/2022	2023.01	05/04/2022 04:38:21 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	805	0	2023	Southern California Group Part A B Part D		1	2251550	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	1	1						05/04/2022	2023.01	05/04/2022 04:38:36 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	806	0	2023	Northern California Group Part A B Part D		1	2471731	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	1	1						05/04/2022	2023.01	05/04/2022 04:38:48 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	807	0	2023	Southern California Group Part B only  Part D		1	30317	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	1	1						05/04/2022	2023.01	05/04/2022 04:39:01 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	808	0	2023	Northern California Group Part B only Part D		1	6830	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	1	1						05/04/2022	2023.01	05/04/2022 04:39:14 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	01	01		1			H0524	809	0	2023	Southern California Plan		1	147474	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;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	1	1						05/04/2022	2023.01	05/04/2022 04:39:25 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	01	01		1			H0524	810	0	2023	Northern California Plan		1	127844	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	1	1						05/04/2022	2023.01	05/04/2022 04:39:36 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	01	01		2	1		H0524	811	0	2023	Southern California Plan		1	96	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	1	1						05/04/2022	2023.01	05/04/2022 04:39:46 PM Pacific Daylight Time					05/20/2022 01:10:13 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	01	01		2	1		H0524	812	0	2023	Northern California Plan		1	278	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	1	1						05/31/2022	2023.01	05/31/2022 05:32:57 PM Pacific Daylight Time		05/31/2022 05:29:33 PM Pacific Daylight Time			05/31/2022 05:35:30 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	2023	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	1	1						05/31/2022	2023.01	05/31/2022 05:33:35 PM Pacific Daylight Time		05/31/2022 05:29:33 PM Pacific Daylight Time			05/31/2022 05:35:30 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	2023	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	013	0	1	02	01	H0543_013_0	2	1					1	08/02/2022	2023.01	08/02/2022 08:15:24 AM Central Daylight Time	08/03/2022 12:19:32 PM Central Daylight Time	07/30/2022 11:31:42 PM Central Daylight Time			08/04/2022 09:04:18 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Value (HMO-POS)	01	02		1			H0543	013	0	2023	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	02	01	H0543_019_0	2	1					1	08/02/2022	2023.01	08/02/2022 08:18:48 AM Central Daylight Time	08/03/2022 12:20:16 PM Central Daylight Time	07/30/2022 11:32:06 PM Central Daylight Time			08/04/2022 09:04:18 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	019	0	2023	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	02	01	H0543_022_0	2	1					1	08/02/2022	2023.01	08/02/2022 08:22:51 AM Central Daylight Time	08/03/2022 12:20:58 PM Central Daylight Time	07/30/2022 11:32:30 PM Central Daylight Time			08/04/2022 09:04:18 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	022	0	2023	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	02	01	H0543_028_0	2	1					1	08/02/2022	2023.01	08/02/2022 08:28:54 AM Central Daylight Time	08/03/2022 12:21:39 PM Central Daylight Time	07/30/2022 11:32:54 PM Central Daylight Time			08/04/2022 09:04:18 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	01	02		1			H0543	028	0	2023	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	02	01	H0543_029_0	2	1					1	05/30/2022	2023.01	05/30/2022 03:23:18 PM Central Daylight Time	08/03/2022 12:22:23 PM Central Daylight Time	07/30/2022 11:33:18 PM Central Daylight Time			08/04/2022 09:10:46 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	029	0	2023	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	035	0	1	02	01	H0543_035_0	2	1					1	05/30/2022	2023.01	05/30/2022 03:29:23 PM Central Daylight Time	08/03/2022 12:23:04 PM Central Daylight Time	07/30/2022 11:33:42 PM Central Daylight Time			08/04/2022 09:10:46 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	035	0	2023	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	02	01	H0543_036_0	2	1					1	05/30/2022	2023.01	05/30/2022 03:32:36 PM Central Daylight Time	08/03/2022 12:23:48 PM Central Daylight Time	07/30/2022 11:34:06 PM Central Daylight Time			08/04/2022 09:10:46 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	01	02		1			H0543	036	0	2023	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	02	01	H0543_060_0	2	1					1	05/30/2022	2023.01	05/30/2022 03:34:58 PM Central Daylight Time	08/03/2022 12:24:32 PM Central Daylight Time	07/30/2022 11:34:30 PM Central Daylight Time			08/04/2022 09:10:46 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO-POS)	01	02		1			H0543	060	0	2023	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	02	01	H0543_070_0	2	1					1	05/30/2022	2023.01	05/30/2022 03:37:22 PM Central Daylight Time	08/03/2022 12:25:15 PM Central Daylight Time	07/30/2022 11:34:54 PM Central Daylight Time			08/04/2022 09:10:46 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	01	02		1			H0543	070	0	2023	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	02	01	H0543_086_0	2	1					1	05/30/2022	2023.01	05/30/2022 03:40:36 PM Central Daylight Time	08/03/2022 12:26:00 PM Central Daylight Time	07/30/2022 11:35:18 PM Central Daylight Time			08/04/2022 09:10:46 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	086	0	2023	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	02	01	H0543_089_0	2	1					1	05/30/2022	2023.01	05/30/2022 03:43:09 PM Central Daylight Time	08/03/2022 12:26:41 PM Central Daylight Time	07/30/2022 11:35:42 PM Central Daylight Time			08/04/2022 09:10:46 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	089	0	2023	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	02	01	H0543_121_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 03:46:59 PM Central Daylight Time	06/01/2022 11:10:23 AM Central Daylight Time				06/02/2022 11:46:09 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H0543	121	0	2023	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	140	0	1	02	01	H0543_140_0	2	1					1	05/30/2022	2023.01	05/30/2022 03:52:59 PM Central Daylight Time	08/03/2022 12:27:25 PM Central Daylight Time	07/30/2022 11:36:06 PM Central Daylight Time			08/04/2022 09:17:42 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	140	0	2023	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	145	0	1	02	01	H0543_145_0	2	1					1	08/02/2022	2023.01	08/02/2022 02:06:46 PM Central Daylight Time	08/03/2022 12:28:06 PM Central Daylight Time	07/30/2022 11:36:30 PM Central Daylight Time			08/04/2022 09:17:42 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	Sharp SecureHorizons Plan by UnitedHealthcare (HMO-POS)	01	02		1			H0543	145	0	2023	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	02	01	H0543_146_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:38:07 AM Central Daylight Time	08/03/2022 12:28:51 PM Central Daylight Time	07/30/2022 11:36:54 PM Central Daylight Time			08/04/2022 09:17:42 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus 1 (HMO-POS)	01	02		1			H0543	146	0	2023	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	02	01	H0543_147_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:38:53 AM Central Daylight Time	08/03/2022 12:29:34 PM Central Daylight Time	07/30/2022 11:37:18 PM Central Daylight Time			08/04/2022 09:17:42 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)	01	02		1			H0543	147	0	2023	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	02	01	H0543_148_0	2	1					1	05/30/2022	2023.01	05/30/2022 04:04:48 PM Central Daylight Time	08/03/2022 12:30:17 PM Central Daylight Time	07/30/2022 11:37:42 PM Central Daylight Time			08/04/2022 09:17:42 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	01	02		1			H0543	148	0	2023	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	02	01	H0543_151_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:31:12 AM Central Daylight Time	08/03/2022 12:30:58 PM Central Daylight Time	07/30/2022 11:38:06 PM Central Daylight Time			08/04/2022 09:17:42 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Harmony (HMO-POS)	01	02		1			H0543	151	0	2023	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	02	01	H0543_152_0	2	1					1	08/02/2022	2023.01	08/02/2022 09:58:29 AM Central Daylight Time	08/03/2022 12:31:43 PM Central Daylight Time	07/30/2022 11:38:30 PM Central Daylight Time			08/04/2022 09:17:42 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 4 (HMO-POS)	01	02		1			H0543	152	0	2023	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	164	0	1	02	01	H0543_164_0	2	1					1	05/30/2022	2023.01	05/30/2022 04:16:42 PM Central Daylight Time	08/03/2022 12:32:25 PM Central Daylight Time	07/30/2022 11:38:54 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO-POS)	01	02		1			H0543	164	0	2023	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	02	01	H0543_165_0	2	1					1	05/30/2022	2023.01	05/30/2022 04:18:30 PM Central Daylight Time	08/03/2022 12:33:08 PM Central Daylight Time	07/30/2022 11:39:18 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO-POS)	01	02		1			H0543	165	0	2023	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	02	01	H0543_166_0	2	1					1	05/30/2022	2023.01	05/30/2022 04:20:14 PM Central Daylight Time	08/03/2022 12:33:52 PM Central Daylight Time	07/30/2022 11:39:41 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO-POS)	01	02		1			H0543	166	0	2023	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	02	01	H0543_167_0	3	1					1	08/02/2022	2023.01	08/02/2022 11:33:28 AM Central Daylight Time	08/03/2022 12:34:33 PM Central Daylight Time	07/30/2022 11:40:05 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)	01	02		1			H0543	167	0	2023	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	02	01	H0543_168_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:39:40 AM Central Daylight Time	08/03/2022 12:35:13 PM Central Daylight Time	07/30/2022 11:40:29 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO-POS)	01	02		1			H0543	168	0	2023	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	02	01	H0543_169_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:39:19 AM Central Daylight Time	08/03/2022 12:35:54 PM Central Daylight Time	07/30/2022 11:40:53 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO-POS)	01	02		1			H0543	169	0	2023	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	02	01	H0543_170_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:40:25 AM Central Daylight Time	08/03/2022 12:36:36 PM Central Daylight Time	07/30/2022 11:41:17 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO-POS)	01	02		1			H0543	170	0	2023	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	176	0	1	02	01	H0543_176_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:41:10 AM Central Daylight Time	08/03/2022 12:37:21 PM Central Daylight Time	07/30/2022 11:41:41 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	176	0	2023	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	02	01	H0543_177_0	2	1					1	05/30/2022	2023.01	05/30/2022 04:29:41 PM Central Daylight Time	08/03/2022 12:38:04 PM Central Daylight Time	07/30/2022 11:42:05 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	177	0	2023	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	02	01	H0543_178_0	2	1					1	05/30/2022	2023.01	05/30/2022 04:42:04 PM Central Daylight Time	08/03/2022 12:38:46 PM Central Daylight Time	07/30/2022 11:42:29 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	178	0	2023	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	02	01	H0543_179_0	2	1					1	05/30/2022	2023.01	05/30/2022 04:45:00 PM Central Daylight Time	08/03/2022 12:39:29 PM Central Daylight Time	07/30/2022 11:42:53 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	179	0	2023	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	2	1					0	08/02/2022	2023.01	08/02/2022 10:02:33 AM Central Daylight Time	08/03/2022 12:40:14 PM Central Daylight Time	07/30/2022 11:43:17 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	01	01		1			H0543	183	0	2023	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	02	01	H0543_188_0	2	1					1	05/30/2022	2023.01	05/30/2022 04:51:31 PM Central Daylight Time	08/03/2022 12:40:56 PM Central Daylight Time	07/30/2022 11:43:41 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO-POS)	01	02		1			H0543	188	0	2023	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	02	01	H0543_189_0	2	1					1	06/01/2022	2023.01	06/01/2022 08:28:57 AM Central Daylight Time	08/03/2022 12:41:38 PM Central Daylight Time	07/30/2022 11:44:06 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO-POS)	01	02		1			H0543	189	0	2023	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	02	01	H0543_191_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:43:36 AM Central Daylight Time	08/03/2022 12:42:22 PM Central Daylight Time	07/30/2022 11:44:30 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO-POS)	01	02		1			H0543	191	0	2023	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	02	01	H0543_193_0	2	1					1	08/02/2022	2023.01	08/02/2022 02:08:35 PM Central Daylight Time	08/03/2022 12:43:05 PM Central Daylight Time	07/30/2022 11:44:54 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO-POS)	01	02		1			H0543	193	0	2023	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	195	0	1	02	01	H0543_195_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:43:53 AM Central Daylight Time	08/03/2022 12:43:48 PM Central Daylight Time	07/30/2022 11:45:18 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H0543	195	0	2023	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	02	01	H0543_196_0	2	1					1	08/02/2022	2023.01	08/02/2022 02:10:45 PM Central Daylight Time	08/03/2022 12:44:32 PM Central Daylight Time	07/30/2022 11:45:42 PM Central Daylight Time			08/05/2022 07:38:47 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO-POS)	01	02		1			H0543	196	0	2023	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	204	0	1	02	01	H0543_204_0	2	1					1	08/02/2022	2023.01	08/02/2022 02:11:37 PM Central Daylight Time	08/03/2022 12:45:14 PM Central Daylight Time	07/30/2022 11:46:07 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	Sharp Walgreens by UnitedHealthcare (HMO-POS)	01	02		1			H0543	204	0	2023	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	02	01	H0543_205_0	2	1					1	05/30/2022	2023.01	05/30/2022 05:14:35 PM Central Daylight Time	08/03/2022 12:45:58 PM Central Daylight Time	07/30/2022 11:46:30 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO-POS)	01	02		1			H0543	205	0	2023	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	02	01	H0543_209_0	2	1					1	05/30/2022	2023.01	05/30/2022 05:16:22 PM Central Daylight Time	08/03/2022 12:46:39 PM Central Daylight Time	07/30/2022 11:46:54 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO-POS)	01	02		1			H0543	209	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:53:16 AM Central Daylight Time	08/03/2022 12:47:22 PM Central Daylight Time	07/30/2022 11:47:18 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Freedom Plus (HMO-POS)	01	02		1			H0543	210	0	2023	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	02	01	H0543_214_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 10:18:03 AM Central Daylight Time	08/03/2022 12:48:06 PM Central Daylight Time	07/30/2022 11:47:42 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Focus (HMO-POS C-SNP)	01	02		1			H0543	214	0	2023	San Diego County		2		2			1	4			00000000000000000010000					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	2	1					1	08/02/2022	2023.01	08/02/2022 12:57:25 PM Central Daylight Time	08/03/2022 12:48:48 PM Central Daylight Time	07/30/2022 11:48:07 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Freedom Plus (HMO-POS)	01	02		1			H0543	215	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 12:58:12 PM Central Daylight Time	08/03/2022 12:49:31 PM Central Daylight Time	07/30/2022 11:48:30 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Freedom Plus (HMO-POS)	01	02		1			H0543	216	0	2023	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	02	01	H0543_217_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 10:19:03 AM Central Daylight Time	08/03/2022 12:50:13 PM Central Daylight Time	07/30/2022 11:48:54 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H0543	217	0	2023	Los Angeles county		2		2			1	4			00000000000000000010000					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	02	01	H0543_218_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 10:19:26 AM Central Daylight Time	08/03/2022 12:50:55 PM Central Daylight Time	07/30/2022 11:49:18 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H0543	218	0	2023	Orange County		2		2			1	4			00000000000000000010000					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	02	01	H0543_219_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 10:19:43 AM Central Daylight Time	08/03/2022 12:51:36 PM Central Daylight Time	07/30/2022 11:49:42 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H0543	219	0	2023	Riverside and San Bernardino counties		2		2			1	4			00000000000000000010000					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	02	01	H0543_220_0	2	1					1	08/02/2022	2023.01	08/02/2022 01:03:41 PM Central Daylight Time	08/03/2022 12:52:20 PM Central Daylight Time	07/30/2022 11:50:05 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Harmony (HMO-POS)	01	02		1			H0543	220	0	2023	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	02	01	H0543_221_0	2	1					1	08/02/2022	2023.01	08/02/2022 01:04:49 PM Central Daylight Time	08/03/2022 12:53:01 PM Central Daylight Time	07/30/2022 11:50:29 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Harmony (HMO-POS)	01	02		1			H0543	221	0	2023	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	02	01	H0543_222_0	2	1					1	08/02/2022	2023.01	08/02/2022 01:07:05 PM Central Daylight Time	08/03/2022 12:53:43 PM Central Daylight Time	07/30/2022 11:50:53 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus 2 (HMO-POS)	01	02		1			H0543	222	0	2023	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	02	01	H0543_223_0	3	1					1	08/02/2022	2023.01	08/02/2022 10:51:57 AM Central Daylight Time	08/03/2022 12:54:24 PM Central Daylight Time	07/30/2022 11:51:17 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H0543	223	0	2023	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	02	01	H0543_224_0	2	1		1			1	05/30/2022	2023.01	05/30/2022 06:22:29 PM Central Daylight Time	08/03/2022 12:55:05 PM Central Daylight Time	07/30/2022 11:51:41 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H0543	224	0	2023	Marin county		2		2			1	4			00000000000000000010000					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	225	0	1	02	01	H0543_225_0	3	1					1	08/03/2022	2023.01	08/03/2022 10:58:12 AM Central Daylight Time	08/03/2022 12:55:47 PM Central Daylight Time	07/30/2022 11:52:05 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Freedom Plus (HMO-POS)	01	02		1			H0543	225	0	2023	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	226	0	1	02	01	H0543_226_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 10:20:02 AM Central Daylight Time	08/03/2022 12:56:27 PM Central Daylight Time	07/30/2022 11:52:29 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H0543	226	0	2023	Kern County		2		2			1	4			00000000000000000010000					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	227	0	1	02	01	H0543_227_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 10:20:20 AM Central Daylight Time	08/03/2022 12:57:09 PM Central Daylight Time	07/30/2022 11:52:53 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H0543	227	0	2023	Ventura County		2		2			1	4			00000000000000000010000					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	228	0	1	02	01	H0543_228_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:52:12 AM Central Daylight Time	08/03/2022 12:57:49 PM Central Daylight Time	07/30/2022 11:53:17 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H0543	228	0	2023	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	2			
H0543	229	0	1	02	01	H0543_229_0	2	1					1	05/30/2022	2023.01	05/30/2022 06:03:10 PM Central Daylight Time	08/03/2022 12:58:30 PM Central Daylight Time	07/30/2022 11:53:41 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H0543	229	0	2023	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	230	0	1	02	01	H0543_230_0	2	1					1	05/30/2022	2023.01	05/30/2022 06:01:06 PM Central Daylight Time	08/03/2022 12:59:11 PM Central Daylight Time	07/30/2022 11:54:05 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H0543	230	0	2023	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	231	0	1	02	01	H0543_231_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:56:18 AM Central Daylight Time	08/03/2022 12:59:53 PM Central Daylight Time	07/30/2022 11:54:29 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus Plan 1 (HMO-POS)	01	02		1			H0543	231	0	2023	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	232	0	1	02	01	H0543_232_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:56:34 AM Central Daylight Time	08/03/2022 01:00:34 PM Central Daylight Time	07/30/2022 11:54:53 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H0543	232	0	2023	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	234	0	1	02	01	H0543_234_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:56:51 AM Central Daylight Time	08/03/2022 01:01:15 PM Central Daylight Time	07/30/2022 11:55:17 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus Plan 2 (HMO-POS)	01	02		1			H0543	234	0	2023	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	235	0	1	02	01	H0543_235_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:57:11 AM Central Daylight Time	08/03/2022 01:01:55 PM Central Daylight Time	07/30/2022 11:55:41 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H0543	235	0	2023	Alameda 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	236	0	1	02	01	H0543_236_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:07:00 AM Central Daylight Time	08/03/2022 01:02:37 PM Central Daylight Time	07/30/2022 11:56:05 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H0543	236	0	2023	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	237	0	1	02	01	H0543_237_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:11:24 AM Central Daylight Time	08/03/2022 01:03:18 PM Central Daylight Time	07/30/2022 11:56:29 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H0543	237	0	2023	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	238	0	1	02	01	H0543_238_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:11:38 AM Central Daylight Time	08/03/2022 01:04:00 PM Central Daylight Time	07/30/2022 11:56:53 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H0543	238	0	2023	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	239	0	1	01	01	H0543_239_0	2	1		1			0	05/30/2022	2023.01	05/30/2022 05:43:21 PM Central Daylight Time	08/03/2022 01:04:41 PM Central Daylight Time	07/30/2022 11:57:17 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Focus (HMO C-SNP)	01	01		1			H0543	239	0	2023	Los Angeles County		2		2			1	4			00000000000000000010000					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	240	0	1	01	01	H0543_240_0	2	1		1			0	05/30/2022	2023.01	05/30/2022 05:41:13 PM Central Daylight Time	08/03/2022 01:05:25 PM Central Daylight Time	07/30/2022 11:57:41 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Focus (HMO C-SNP)	01	01		1			H0543	240	0	2023	Orange County		2		2			1	4			00000000000000000010000					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	241	0	1	01	01	H0543_241_0	2	1		1			0	05/30/2022	2023.01	05/30/2022 05:39:04 PM Central Daylight Time	08/03/2022 01:06:06 PM Central Daylight Time	07/30/2022 11:58:06 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Focus (HMO C-SNP)	01	01		1			H0543	241	0	2023	Riverside and San Bernardino Counties		2		2			1	4			00000000000000000010000					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	242	0	1	01	01	H0543_242_0	2	1		1			0	05/30/2022	2023.01	05/30/2022 05:36:58 PM Central Daylight Time	08/03/2022 01:06:48 PM Central Daylight Time	07/30/2022 11:58:30 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Focus (HMO C-SNP)	01	01		1			H0543	242	0	2023	Kern County		2		2			1	4			00000000000000000010000					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	243	0	1	01	01	H0543_243_0	3	1		1			0	07/18/2022	2023.01	07/18/2022 09:27:05 AM Central Daylight Time	08/03/2022 01:07:29 PM Central Daylight Time	07/30/2022 11:58:54 PM Central Daylight Time			08/04/2022 08:54:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Focus (HMO C-SNP)	01	01		1			H0543	243	0	2023	Ventura County		2		2			1	4			00000000000000000010000					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	06/03/2022	2023.01	06/03/2022 09:24:45 AM Central Daylight Time					06/03/2022 03:14:28 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	802	0	2023	CA Employer Sponsored Plan Service Area		1	16032	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						06/03/2022	2023.01	06/03/2022 09:25:45 AM Central Daylight Time					06/03/2022 03:14:28 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	805	0	2023	CA Employer Sponsored Plan Service Area		1	140676	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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						06/03/2022	2023.01	06/03/2022 09:26:56 AM Central Daylight Time					06/03/2022 03:14:28 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	806	0	2023	CA Employer Sponsored Plan Service Area		1	59268	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	6	1			2		0	08/01/2022	2023.01	08/01/2022 01:17:31 PM Pacific Daylight Time	08/04/2022 03:14:15 PM Pacific Daylight Time	08/04/2022 03:25:07 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	6	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 07:25:36 PM Eastern Daylight Time	08/04/2022 06:14:58 PM Eastern Daylight Time	08/04/2022 06:26:38 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	6	1		1	2		1	08/01/2022	2023.01	08/01/2022 01:21:07 PM Pacific Daylight Time	08/04/2022 03:14:16 PM Pacific Daylight Time	08/04/2022 03:25:09 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Los Angeles and Orange Counties		2		2			1	4			00000010000000000000000					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	6	1		1	2		0	07/11/2022	2023.01	07/11/2022 09:52:45 AM Pacific Daylight Time	08/04/2022 03:14:17 PM Pacific Daylight Time	08/04/2022 03:25:12 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	6	1			2		0	08/01/2022	2023.01	08/01/2022 01:22:46 PM Pacific Daylight Time	08/04/2022 03:14:18 PM Pacific Daylight Time	08/04/2022 03:25:14 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	6	1			2		0	08/01/2022	2023.01	08/01/2022 01:24:44 PM Pacific Daylight Time	08/04/2022 03:14:20 PM Pacific Daylight Time	08/04/2022 03:25:17 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	09/23/2022	2023.01	09/23/2022 01:50:54 PM Pacific Daylight Time	08/04/2022 03:14:21 PM Pacific Daylight Time	08/04/2022 03:25:20 PM Pacific Daylight Time			09/27/2022 08:22:23 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	2023	San Bernardino County		2		2			1	4			00000010000000000000000					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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 03:08:50 PM Pacific Daylight Time	08/04/2022 03:14:22 PM Pacific Daylight Time	08/04/2022 03:25:23 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Los Angeles and Orange Counties		2		2			1	4			00000000000000010000000					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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 01:33:35 PM Pacific Daylight Time	08/04/2022 03:14:23 PM Pacific Daylight Time	08/04/2022 03:25:25 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Los Angeles and Orange Counties		2		2			1	4			00000000000100000000000					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	08/01/2022	2023.01	08/01/2022 03:09:29 PM Pacific Daylight Time		08/04/2022 03:25:28 PM Pacific Daylight Time		08/04/2022 03:14:25 PM Pacific Daylight Time	08/19/2022 08:32:38 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	2023	Los Angeles and Orange Counties		2		2			1	4			00000000100000000000000					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	7	1		1	2		0	09/23/2022	2023.01	09/23/2022 01:52:47 PM Pacific Daylight Time	08/04/2022 03:14:26 PM Pacific Daylight Time	08/04/2022 03:25:31 PM Pacific Daylight Time			09/27/2022 08:22:23 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	2023	San Bernardino County		2		2			1	4			00000000000100000000000					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	7	1		1	2		0	08/01/2022	2023.01	08/01/2022 01:38:06 PM Pacific Daylight Time		08/04/2022 03:25:33 PM Pacific Daylight Time		08/04/2022 03:14:27 PM Pacific Daylight Time	08/19/2022 08:32:38 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	2023	San Bernardino County		2		2			1	4			00000000100000000000000					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	6	1			2		0	08/01/2022	2023.01	08/01/2022 01:39:52 PM Pacific Daylight Time	08/04/2022 03:14:28 PM Pacific Daylight Time	08/04/2022 03:25:36 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 01:41:22 PM Pacific Daylight Time	08/04/2022 03:14:30 PM Pacific Daylight Time	08/04/2022 03:25:39 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Stanislaus County		2		2			1	4			00000000000100000000000					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	6	1		1	2		1	08/01/2022	2023.01	08/01/2022 01:43:08 PM Pacific Daylight Time	08/04/2022 03:14:31 PM Pacific Daylight Time	08/04/2022 03:25:41 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Stanislaus County		2		2			1	4			00000010000000000000000					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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 04:22:30 PM Pacific Daylight Time	08/04/2022 03:14:32 PM Pacific Daylight Time	08/04/2022 03:25:44 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Stanislaus County		2		2			1	4			00000000000000010000000					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	7	1		1	2		0	09/23/2022	2023.01	09/23/2022 01:53:54 PM Pacific Daylight Time	08/04/2022 03:14:34 PM Pacific Daylight Time	08/04/2022 03:25:47 PM Pacific Daylight Time			09/27/2022 08:22:23 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	2023	San Bernardino County		2		2			1	4			00000000000000010000000					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	6	1		1	2		0	07/11/2022	2023.01	07/11/2022 09:50:19 AM Pacific Daylight Time	08/04/2022 03:14:35 PM Pacific Daylight Time	08/04/2022 03:25:49 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	5	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 03:24:58 PM Eastern Daylight Time	08/04/2022 06:14:59 PM Eastern Daylight Time	08/04/2022 06:26:41 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 09:53:06 AM Eastern Daylight Time	08/04/2022 06:15:00 PM Eastern Daylight Time	08/04/2022 06:26:43 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 09:54:12 AM Eastern Daylight Time	08/04/2022 06:15:02 PM Eastern Daylight Time	08/04/2022 06:26:46 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 09:55:13 AM Eastern Daylight Time	08/04/2022 06:15:03 PM Eastern Daylight Time	08/04/2022 06:26:49 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:46:33 PM Pacific Daylight Time	08/04/2022 03:15:51 PM Pacific Daylight Time	08/04/2022 03:28:22 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		1	08/01/2022	2023.01	08/01/2022 12:36:51 PM Pacific Daylight Time	08/04/2022 03:15:52 PM Pacific Daylight Time	08/04/2022 03:28:25 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:46:56 PM Pacific Daylight Time	08/04/2022 03:15:54 PM Pacific Daylight Time	08/04/2022 03:28:27 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:38:12 PM Pacific Daylight Time	08/04/2022 03:15:55 PM Pacific Daylight Time	08/04/2022 03:28:30 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:47:23 PM Pacific Daylight Time	08/04/2022 03:15:57 PM Pacific Daylight Time	08/04/2022 03:28:33 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:47:34 PM Pacific Daylight Time	08/04/2022 03:15:58 PM Pacific Daylight Time	08/04/2022 03:28:35 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:47:44 PM Pacific Daylight Time	08/04/2022 03:16:00 PM Pacific Daylight Time	08/04/2022 03:28:38 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:39:45 PM Pacific Daylight Time	08/04/2022 03:16:01 PM Pacific Daylight Time	08/04/2022 03:28:41 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	05/26/2022	2023.01	05/26/2022 03:41:50 PM Pacific Daylight Time	08/04/2022 03:16:03 PM Pacific Daylight Time	08/04/2022 03:28:44 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	081	0	1	01	01	H0544_081_0	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:42:20 PM Pacific Daylight Time	08/04/2022 03:16:04 PM Pacific Daylight Time	08/04/2022 03:28:46 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	(888)230-7338		(888)230-7338		(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	6	1	2	1	1		0	06/28/2022	2023.01	06/28/2022 12:58:16 PM Eastern Daylight Time	08/04/2022 06:15:05 PM Eastern Daylight Time	08/04/2022 06:26:51 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:04:12 AM Eastern Daylight Time	08/04/2022 06:15:06 PM Eastern Daylight Time	08/04/2022 06:26:54 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:05:02 AM Eastern Daylight Time	08/04/2022 06:15:07 PM Eastern Daylight Time	08/04/2022 06:26:57 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:06:21 AM Eastern Daylight Time	08/04/2022 06:15:09 PM Eastern Daylight Time	08/04/2022 06:26:59 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:48:30 PM Pacific Daylight Time	08/04/2022 03:16:06 PM Pacific Daylight Time	08/04/2022 03:28:49 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:25:49 PM Pacific Daylight Time	08/04/2022 03:19:40 PM Pacific Daylight Time	08/04/2022 03:35:34 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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	5	1		1	2		1	08/02/2022	2023.01	08/02/2022 12:05:16 AM Pacific Daylight Time	08/04/2022 03:19:42 PM Pacific Daylight Time	08/04/2022 03:35:37 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Sacramento County		2		2			1	4			00000010000000000000000					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	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:45:06 PM Pacific Daylight Time	08/04/2022 03:16:07 PM Pacific Daylight Time	08/04/2022 03:28:51 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:48:49 PM Pacific Daylight Time	08/04/2022 03:16:09 PM Pacific Daylight Time	08/04/2022 03:28:54 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	098	0	1	01	01	H0544_098_0	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:48:58 PM Pacific Daylight Time	08/04/2022 03:16:10 PM Pacific Daylight Time	08/04/2022 03:28:57 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:49:28 PM Pacific Daylight Time	08/04/2022 03:16:12 PM Pacific Daylight Time	08/04/2022 03:29:00 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1	2	1	1		0	06/07/2022	2023.01	06/07/2022 10:48:12 PM Eastern Daylight Time	08/04/2022 06:15:10 PM Eastern Daylight Time	08/04/2022 06:27:02 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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)469-6831		(844)469-6831		(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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 04:23:17 PM Pacific Daylight Time	08/04/2022 03:14:36 PM Pacific Daylight Time	08/04/2022 03:25:52 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Santa Clara County		2		2			1	4			00000000000100000000000					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	6	1		1	2		1	08/01/2022	2023.01	08/01/2022 04:23:48 PM Pacific Daylight Time	08/04/2022 03:14:37 PM Pacific Daylight Time	08/04/2022 03:25:55 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Santa Clara County		2		2			1	4			00000010000000000000000					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	7	1		1	2		0	07/11/2022	2023.01	07/11/2022 09:51:38 AM Pacific Daylight Time	08/04/2022 03:14:39 PM Pacific Daylight Time	08/04/2022 03:25:57 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Stanislaus County		2		2			1	4			00000000000100000000000					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	6	1		1	2		1	07/11/2022	2023.01	07/11/2022 09:52:13 AM Pacific Daylight Time	08/04/2022 03:14:40 PM Pacific Daylight Time	08/04/2022 03:26:00 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Stanislaus County		2		2			1	4			00000010000000000000000					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	6	1		1	2		0	07/11/2022	2023.01	07/11/2022 09:52:28 AM Pacific Daylight Time	08/04/2022 03:14:41 PM Pacific Daylight Time	08/04/2022 03:26:03 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Stanislaus County		2		2			1	4			00000000000000010000000					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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 04:24:16 PM Pacific Daylight Time	08/04/2022 03:14:43 PM Pacific Daylight Time	08/04/2022 03:26:05 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Santa Clara County		2		2			1	4			00000000000000010000000					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	6	1			2		0	05/24/2022	2023.01	05/24/2022 05:01:52 PM Pacific Daylight Time	08/04/2022 03:14:44 PM Pacific Daylight Time	08/04/2022 03:26:08 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:49:22 PM Pacific Daylight Time	08/04/2022 03:16:13 PM Pacific Daylight Time	08/04/2022 03:29:02 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:51:20 PM Pacific Daylight Time	08/04/2022 03:16:14 PM Pacific Daylight Time	08/04/2022 03:29:05 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 02:04:47 PM Pacific Daylight Time	08/04/2022 03:14:46 PM Pacific Daylight Time	08/04/2022 03:26:11 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Santa Clara and San Benito Counties	Santa Clara County	2		2			1	4			00000000000100000000000					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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 02:06:19 PM Pacific Daylight Time	08/04/2022 03:14:47 PM Pacific Daylight Time	08/04/2022 03:26:13 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Santa Clara and San Benito Counties	San Benito County	2		2			1	4			00000000000100000000000					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	6	1		1	2		1	08/01/2022	2023.01	08/01/2022 02:07:59 PM Pacific Daylight Time	08/04/2022 03:14:48 PM Pacific Daylight Time	08/04/2022 03:26:16 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Santa Clara and San Benito Counties	San Benito County	2		2			1	4			00000010000000000000000					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	6	1		1	2		1	08/01/2022	2023.01	08/01/2022 02:10:08 PM Pacific Daylight Time	08/04/2022 03:14:49 PM Pacific Daylight Time	08/04/2022 03:26:19 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Santa Clara and San Benito Counties	Santa Clara County	2		2			1	4			00000010000000000000000					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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 02:17:45 PM Pacific Daylight Time	08/04/2022 03:14:50 PM Pacific Daylight Time	08/04/2022 03:26:22 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Santa Clara and San Benito Counties	San Benito County	2		2			1	4			00000000000000010000000					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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 02:19:52 PM Pacific Daylight Time	08/04/2022 03:14:52 PM Pacific Daylight Time	08/04/2022 03:26:24 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	Santa Clara and San Benito Counties	Santa Clara County	2		2			1	4			00000000000000010000000					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	5	1			2		0	08/01/2022	2023.01	08/01/2022 02:21:34 PM Pacific Daylight Time	08/04/2022 03:14:53 PM Pacific Daylight Time	08/04/2022 03:26:27 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	5	1			2		0	08/01/2022	2023.01	08/01/2022 02:23:23 PM Pacific Daylight Time	08/04/2022 03:14:54 PM Pacific Daylight Time	08/04/2022 03:26:30 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	6	1			2		0	08/01/2022	2023.01	08/01/2022 02:25:03 PM Pacific Daylight Time	08/04/2022 03:14:55 PM Pacific Daylight Time	08/04/2022 03:26:32 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	6	1			2		0	08/01/2022	2023.01	08/01/2022 02:26:30 PM Pacific Daylight Time	08/04/2022 03:14:56 PM Pacific Daylight Time	08/04/2022 03:26:35 PM Pacific Daylight Time			08/04/2022 04:07:02 PM 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	2023	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	5	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 10:29:35 AM Eastern Daylight Time	08/04/2022 06:15:11 PM Eastern Daylight Time	08/04/2022 06:27:05 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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)469-6831		(844)469-6831		(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	8	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 10:29:46 AM Eastern Daylight Time	08/04/2022 06:15:13 PM Eastern Daylight Time	08/04/2022 06:27:07 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	(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	127	0	1	01	01	H0544_127_0	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:49:43 PM Pacific Daylight Time	08/04/2022 03:16:17 PM Pacific Daylight Time	08/04/2022 03:29:08 PM Pacific Daylight Time			08/04/2022 07:03:00 PM 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	2023	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	129	0	1	01	01	H0544_129_0	7	1	2	1	1		0	07/11/2022	2023.01	07/11/2022 05:09:04 PM Eastern Daylight Time	08/04/2022 06:15:14 PM Eastern Daylight Time	08/04/2022 06:27:10 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	(844)469-6831		(844)469-6831		(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	2	1				0	0	05/20/2022	2023.01	05/20/2022 04:04:34 PM Pacific Daylight Time					06/03/2022 10:21:38 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	2023	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;10a;11a;11b;11c;15;16b;17a;17b;18a;	2		1					1				
H0544	802	0	1	01	01	H0544_802_0	2	1						05/20/2022	2023.01	05/20/2022 04:04:48 PM Pacific Daylight Time					06/03/2022 10:21:38 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	2023	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;10a;11a;11b;11c;15;16b;17a;17b;18a;	2		1					1				
H0544	805	0	1	01	01	H0544_805_0	2	1						05/20/2022	2023.01	05/20/2022 04:00:58 PM Pacific Daylight Time					06/03/2022 10:21:38 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	2023	California, select counties		1	10452	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;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	2	1				0	0	05/20/2022	2023.01	05/20/2022 04:01:35 PM Pacific Daylight Time					06/03/2022 10:21:38 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	2023	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;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	2	1						05/20/2022	2023.01	05/20/2022 04:02:28 PM Pacific Daylight Time					06/03/2022 10:21:38 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	2023	Select counties in California		1	24	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;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	2	1				0	0	05/20/2022	2023.01	05/20/2022 04:02:56 PM Pacific Daylight Time					06/03/2022 10:21:38 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	2023	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;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	2	1				0	0	05/20/2022	2023.01	05/20/2022 04:03:23 PM Pacific Daylight Time					06/03/2022 10:21:38 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	2023	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;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	2	1				0	0	05/20/2022	2023.01	05/20/2022 04:03:53 PM Pacific Daylight Time					06/03/2022 10:21:38 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	2023	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;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				
H0562	009	0	1	01	01	H0562_009_0	5	1						05/25/2022	2023.01	05/25/2022 01:00:19 PM Pacific Daylight Time	08/03/2022 07:46:42 PM Eastern Daylight Time	07/30/2022 07:26:42 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Premium Ultra (HMO)	01	01		1			H0562	009	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	012	0	1	01	01	H0562_012_0	4	1						08/03/2022	2023.01	08/03/2022 03:43:21 PM Eastern Daylight Time	08/03/2022 07:47:52 PM Eastern Daylight Time	07/30/2022 07:27:14 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	012	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	039	0	1	01	01	H0562_039_0	4	1						08/03/2022	2023.01	08/03/2022 03:01:16 PM Eastern Daylight Time	08/03/2022 07:49:01 PM Eastern Daylight Time	07/30/2022 07:27:45 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Premium Ultra (HMO)	01	01		1			H0562	039	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(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	05/25/2022	2023.01	05/25/2022 01:03:45 PM Pacific Daylight Time	06/03/2022 09:17:26 PM Eastern Daylight Time				07/15/2022 03:48:23 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Patriot Giveback (HMO)	01	01		1			H0562	044	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0562	079	0	1	01	01	H0562_079_0	5	1						08/03/2022	2023.01	08/03/2022 03:03:29 PM Eastern Daylight Time	08/03/2022 07:50:12 PM Eastern Daylight Time	07/30/2022 07:28:16 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium Ruby (HMO)	01	01		1			H0562	079	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	084	0	1	01	01	H0562_084_0	5	1						05/25/2022	2023.01	05/25/2022 01:05:48 PM Pacific Daylight Time	08/03/2022 07:51:21 PM Eastern Daylight Time	07/30/2022 07:28:48 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Premium Ultra (HMO)	01	01		1			H0562	084	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	092	0	1	01	01	H0562_092_0	4	1		1	2		1	08/01/2022	2023.01	08/01/2022 12:22:03 PM Eastern Daylight Time	08/03/2022 07:52:30 PM Eastern Daylight Time	07/30/2022 07:29:19 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H0562	092	0	2023	Select counties in CA		2		2			1	4			00000000000000000010000					www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	097	0	1	01	01	H0562_097_0	5	1						08/03/2022	2023.01	08/03/2022 03:05:09 PM Eastern Daylight Time	08/03/2022 07:53:38 PM Eastern Daylight Time	07/30/2022 07:29:50 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	097	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	103	0	1	01	01	H0562_103_0	5	1						08/03/2022	2023.01	08/03/2022 03:07:34 PM Eastern Daylight Time	08/03/2022 07:54:47 PM Eastern Daylight Time	07/30/2022 07:30:21 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	103	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	113	0	1	01	01	H0562_113_0	5	1						08/03/2022	2023.01	08/03/2022 03:09:12 PM Eastern Daylight Time	08/03/2022 07:55:57 PM Eastern Daylight Time	07/30/2022 07:30:52 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	113	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	114	0	1	01	01	H0562_114_0	5	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:12:05 PM Eastern Daylight Time	08/03/2022 07:57:05 PM Eastern Daylight Time	07/30/2022 07:31:24 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H0562	114	0	2023	Select counties in CA		2		2			1	4			00000000000000000010000					www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	118	0	1	01	01	H0562_118_0	4	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:13:50 PM Eastern Daylight Time	08/03/2022 07:58:14 PM Eastern Daylight Time	07/30/2022 07:31:55 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H0562	118	0	2023	Select counties in CA		2		2			1	4			00000000000000000010000					www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	120	0	1	01	01	H0562_120_0	4	1						08/03/2022	2023.01	08/03/2022 03:16:46 PM Eastern Daylight Time	08/03/2022 07:59:24 PM Eastern Daylight Time	07/30/2022 07:32:25 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	120	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	121	0	1	01	01	H0562_121_0	7	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 08:18:18 AM Pacific Daylight Time	08/03/2022 08:00:34 PM Eastern Daylight Time	07/30/2022 07:32:57 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H0562	121	0	2023	Select counties in CA		2		2			1	3		1					1	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	123	0	1	01	01	H0562_123_0	4	1						08/03/2022	2023.01	08/03/2022 03:18:20 PM Eastern Daylight Time	08/03/2022 08:01:46 PM Eastern Daylight Time	07/30/2022 07:33:27 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Low Premium (HMO)	01	01		1			H0562	123	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	124	0	1	01	01	H0562_124_0	5	1						08/03/2022	2023.01	08/03/2022 03:20:15 PM Eastern Daylight Time	08/03/2022 08:02:54 PM Eastern Daylight Time	07/30/2022 07:33:58 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	124	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	125	0	1	01	01	H0562_125_0	4	1						08/01/2022	2023.01	08/01/2022 12:40:50 PM Eastern Daylight Time	08/03/2022 08:04:03 PM Eastern Daylight Time	07/30/2022 07:34:29 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	125	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	126	0	1	01	01	H0562_126_0	4	1						08/03/2022	2023.01	08/03/2022 03:21:59 PM Eastern Daylight Time	08/03/2022 08:05:12 PM Eastern Daylight Time	07/30/2022 07:35:00 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	126	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	127	0	1	01	01	H0562_127_0	4	1						05/25/2022	2023.01	05/25/2022 01:30:28 PM Pacific Daylight Time	08/03/2022 08:06:21 PM Eastern Daylight Time	07/30/2022 07:35:31 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Assist (HMO)	01	01		1			H0562	127	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	128	0	1	01	01	H0562_128_0	4	1						08/01/2022	2023.01	08/01/2022 12:47:56 PM Eastern Daylight Time	08/04/2022 09:48:23 AM Eastern Daylight Time	07/30/2022 07:36:02 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	128	0	2023	Selected counties in California		2		2			2									ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	129	0	1	01	01	H0562_129_0	7	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 08:24:51 AM Pacific Daylight Time	08/03/2022 08:08:40 PM Eastern Daylight Time	07/30/2022 07:36:33 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Dual Align 129 (HMO D-SNP)	01	01		1			H0562	129	0	2023	Selected counties in California		2		2			1	3		1					1	ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	801	0	1	01	01	H0562_801_0	1	1						05/10/2022	2023.01	05/10/2022 09:43:19 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	California		1	100	2			2									ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:43:49 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	California		1	100	2			2									ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 09:44:18 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	California		1	100	2			2									ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	4	1			2		1	08/03/2022	2023.01	08/03/2022 04:59:10 PM Central Daylight Time	08/04/2022 01:57:38 PM Eastern Daylight Time	08/04/2022 01:58:10 PM Eastern Daylight Time			08/07/2022 07:26:59 AM 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	2023	San Francisco and San Mateo Counties		2		2			2									www.cchphealthplan.com/medicare-member/	www.cchphealthplan.com/medicare-member/	www.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;9a2;	
H0571	005	0	1	01	01	H0571_005_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:01:07 PM Central Daylight Time	08/05/2022 01:11:45 PM Eastern Daylight Time	08/04/2022 01:59:38 PM Eastern Daylight Time			08/05/2022 01:35:46 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	2023	San Francisco County		2		2			1	3		1					2	www.cchphealthplan.com/medicare-member/	www.cchphealthplan.com/medicare-member/	www.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	2			
H0571	007	0	1	01	01	H0571_007_0	4	1			2		1	08/04/2022	2023.01	08/04/2022 01:43:48 PM Central Daylight Time	08/04/2022 02:00:39 PM Eastern Daylight Time	08/04/2022 02:01:25 PM Eastern Daylight Time			08/07/2022 07:26:59 AM 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	2023	San Francisco and San Mateo Counties		2		2			2									www.cchphealthplan.com/medicare-member/	www.cchphealthplan.com/medicare-member/	www.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;9a2;	
H0609	007	0	1	02	01	H0609_007_0	3	1					1	08/02/2022	2023.01	08/02/2022 02:47:27 PM Central Daylight Time	08/03/2022 10:31:40 AM Central Daylight Time	07/30/2022 11:59:18 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	01	02		1			H0609	007	0	2023	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	02	01	H0609_012_0	2	1					1	08/02/2022	2023.01	08/02/2022 09:27:30 AM Central Daylight Time	08/03/2022 10:32:17 AM Central Daylight Time	07/30/2022 11:59:42 PM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)	01	02		1			H0609	012	0	2023	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	02	01	H0609_018_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 09:58:06 PM Central Daylight Time	06/01/2022 10:41:24 AM Central Daylight Time				06/02/2022 01:13:21 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H0609	018	0	2023	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	02	01	H0609_025_0	3	1					1	08/02/2022	2023.01	08/02/2022 09:33:11 AM Central Daylight Time	08/03/2022 10:32:53 AM Central Daylight Time	07/31/2022 12:00:06 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H0609	025	0	2023	Pima County		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	026	0	1	02	01	H0609_026_0	2	1					1	08/02/2022	2023.01	08/02/2022 09:38:33 AM Central Daylight Time	08/03/2022 10:33:31 AM Central Daylight Time	07/31/2022 12:00:30 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H0609	026	0	2023	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	02	01	H0609_027_0	2	1					1	08/02/2022	2023.01	08/02/2022 09:50:28 AM Central Daylight Time	08/03/2022 10:34:07 AM Central Daylight Time	07/31/2022 12:00:54 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H0609	027	0	2023	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	028	0	1	02	01	H0609_028_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:28:55 AM Central Daylight Time	08/03/2022 10:34:45 AM Central Daylight Time	07/31/2022 12:01:19 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H0609	028	0	2023	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	02	01	H0609_031_0	2	1					1	08/02/2022	2023.01	08/02/2022 04:19:36 PM Central Daylight Time	08/03/2022 10:35:22 AM Central Daylight Time	07/31/2022 12:01:43 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Premier (HMO-POS)	01	02		1			H0609	031	0	2023	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	02	01	H0609_032_0	3	1					1	08/02/2022	2023.01	08/02/2022 10:33:26 AM Central Daylight Time	08/03/2022 10:35:59 AM Central Daylight Time	07/31/2022 12:02:08 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Focus (HMO-POS)	01	02		1			H0609	032	0	2023	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	02	01	H0609_033_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:35:46 AM Central Daylight Time	08/03/2022 10:36:36 AM Central Daylight Time	07/31/2022 12:02:32 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H0609	033	0	2023	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	02	01	H0609_034_1	2	1					1	08/02/2022	2023.01	08/02/2022 11:04:28 AM Central Daylight Time	08/03/2022 10:37:13 AM Central Daylight Time	07/31/2022 12:02:57 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	01	02		1			H0609	034	1	2023	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	02	01	H0609_034_2	2	1					1	08/04/2022	2023.01	08/04/2022 09:51:22 AM Central Daylight Time	08/03/2022 10:37:51 AM Central Daylight Time	07/31/2022 12:03:21 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	01	02		1			H0609	034	2	2023	Select Counties in Colorado	Select Counties in Colorado	2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	036	1	1	02	01	H0609_036_1	3	1					1	08/04/2022	2023.01	08/04/2022 10:06:45 AM Central Daylight Time	08/03/2022 10:38:27 AM Central Daylight Time	07/31/2022 12:03:46 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)	01	02		1			H0609	036	1	2023	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	02	01	H0609_036_2	2	1					1	08/02/2022	2023.01	08/02/2022 11:23:37 AM Central Daylight Time	08/03/2022 10:39:05 AM Central Daylight Time	07/31/2022 12:04:10 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)	01	02		1			H0609	036	2	2023	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	02	01	H0609_037_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 11:54:40 AM Central Daylight Time	08/03/2022 10:39:41 AM Central Daylight Time	07/31/2022 12:04:34 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (HMO-POS C-SNP)	01	02		1			H0609	037	0	2023	Clark and Nye counties		2		2			1	4			00000000000000000010000					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	02	01	H0609_038_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:12:46 AM Central Daylight Time	08/03/2022 10:40:18 AM Central Daylight Time	07/31/2022 12:04:58 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (HMO-POS)	01	02		1			H0609	038	0	2023	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	02	01	H0609_040_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:38:15 AM Central Daylight Time	08/03/2022 10:40:55 AM Central Daylight Time	07/31/2022 12:05:22 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H0609	040	0	2023	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	02	01	H0609_041_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 10:07:04 PM Central Daylight Time	06/01/2022 10:51:03 AM Central Daylight Time				06/02/2022 01:13:21 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H0609	041	0	2023	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	02	01	H0609_042_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 09:55:57 AM Central Daylight Time	08/03/2022 10:41:33 AM Central Daylight Time	07/31/2022 12:05:46 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H0609	042	0	2023	Maricopa and Pinal Counties		2		2			1	4			00000000000000000010000					www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	043	0	1	02	01	H0609_043_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 10:00:50 AM Central Daylight Time	08/03/2022 10:42:11 AM Central Daylight Time	07/31/2022 12:06:10 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H0609	043	0	2023	Pima County		2		2			1	4			00000000000000000010000					www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	044	0	1	02	01	H0609_044_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:08:20 AM Central Daylight Time	08/03/2022 10:42:49 AM Central Daylight Time	07/31/2022 12:06:34 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO-POS)	01	02		1			H0609	044	0	2023	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	045	0	1	02	01	H0609_045_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:10:35 AM Central Daylight Time	08/03/2022 10:43:26 AM Central Daylight Time	07/31/2022 12:06:58 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H0609	045	0	2023	Pima County		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	046	0	1	02	01	H0609_046_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:01:49 AM Central Daylight Time	08/03/2022 10:44:02 AM Central Daylight Time	07/31/2022 12:07:21 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 4 (HMO-POS)	01	02		1			H0609	046	0	2023	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	047	0	1	02	01	H0609_047_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 10:13:38 AM Central Daylight Time	08/03/2022 10:44:41 AM Central Daylight Time	07/31/2022 12:07:46 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H0609	047	0	2023	Denver Metro area		2		2			1	4			00000000000000000010000					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	048	0	1	02	01	H0609_048_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:14:48 AM Central Daylight Time	08/03/2022 10:45:18 AM Central Daylight Time	07/31/2022 12:08:10 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H0609	048	0	2023	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	049	0	1	02	01	H0609_049_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 10:22:14 AM Central Daylight Time	08/03/2022 10:45:54 AM Central Daylight Time	07/31/2022 12:08:34 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Focus (HMO-POS C-SNP)	01	02		1			H0609	049	0	2023	El Paso county		2		2			1	4			00000000000000000010000					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	801	0	1	01	01	H0609_801_0	1	1				0	0	06/04/2022	2023.01	06/04/2022 10:24:04 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	801	0	2023	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	1	1						06/04/2022	2023.01	06/04/2022 10:24:25 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	804	0	2023	CO Employer Sponsored Plan Service Area		1	3840	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/04/2022	2023.01	06/04/2022 10:24:40 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	805	0	2023	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	1	1						06/04/2022	2023.01	06/04/2022 10:24:58 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H0609	806	0	2023	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	1	1				0	0	06/04/2022	2023.01	06/04/2022 10:25:14 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	807	0	2023	Arizona		1	900	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	1	1						06/04/2022	2023.01	06/04/2022 10:25:52 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	808	0	2023	Arizona		1	221664	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/04/2022	2023.01	06/04/2022 10:26:08 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	809	0	2023	Arizona		1	12	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1				0	0	06/04/2022	2023.01	06/04/2022 10:27:17 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	810	0	2023	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	1	1						06/04/2022	2023.01	06/04/2022 10:28:02 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	811	0	2023	Clark and Nye counties		1	4524	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/04/2022	2023.01	06/04/2022 10:28:15 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	812	0	2023	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	1	1						06/04/2022	2023.01	06/04/2022 10:28:31 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	813	0	2023	NV Employer Sponsored Plan Service Area		1	7956	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1				0	0	06/04/2022	2023.01	06/04/2022 10:28:45 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	814	0	2023	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	1	1						06/04/2022	2023.01	06/04/2022 10:28:58 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	815	0	2023	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	1	1						06/04/2022	2023.01	06/04/2022 10:29:11 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	816	0	2023	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	1	1						06/04/2022	2023.01	06/04/2022 10:29:22 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	817	0	2023	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	1	1				0	0	06/04/2022	2023.01	06/04/2022 10:30:06 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	818	0	2023	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	1	1				0	0	06/04/2022	2023.01	06/04/2022 10:30:31 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	819	0	2023	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	1	1				0	0	06/04/2022	2023.01	06/04/2022 10:30:57 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	820	0	2023	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	1	1				0	0	06/04/2022	2023.01	06/04/2022 10:31:22 AM Central Daylight Time					06/04/2022 10:38:04 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	821	0	2023	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						06/02/2022	2023.01	06/02/2022 09:44:36 AM Mountain Daylight Time		05/31/2022 08:43:34 PM Mountain Daylight Time			06/02/2022 09:49:50 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	2023	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						06/02/2022	2023.01	06/02/2022 09:45:30 AM Mountain Daylight Time		05/31/2022 08:46:04 PM Mountain Daylight Time			06/02/2022 09:49:50 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	2023	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	02	01	H0624_001_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:32:59 PM Central Daylight Time	08/03/2022 12:08:49 PM Central Daylight Time	07/31/2022 12:08:58 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H0624	001	0	2023	Select Counties in Colorado		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	4	1			1			08/02/2022	2023.01	08/02/2022 04:41:49 PM Eastern Daylight Time	08/03/2022 08:22:40 AM Eastern Daylight Time	07/31/2022 08:51:20 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	001	0	2023	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	4	1			2			08/02/2022	2023.01	08/02/2022 04:43:27 PM Eastern Daylight Time	08/03/2022 08:23:36 AM Eastern Daylight Time	07/31/2022 08:51:46 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	003	0	2023	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	4	1			1			08/02/2022	2023.01	08/02/2022 04:44:53 PM Eastern Daylight Time	08/03/2022 08:24:31 AM Eastern Daylight Time	07/31/2022 08:52:12 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	005	0	2023	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	4	1			2			08/02/2022	2023.01	08/02/2022 04:45:51 PM Eastern Daylight Time	08/03/2022 08:25:26 AM Eastern Daylight Time	07/31/2022 08:52:36 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	006	0	2023	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	4	1			2			08/02/2022	2023.01	08/02/2022 04:46:44 PM Eastern Daylight Time	08/03/2022 08:26:22 AM Eastern Daylight Time	07/31/2022 08:53:02 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	007	0	2023	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	4	1			2			08/02/2022	2023.01	08/02/2022 04:47:42 PM Eastern Daylight Time	08/03/2022 08:27:17 AM Eastern Daylight Time	07/31/2022 08:53:26 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	008	0	2023	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	4	1			2			08/02/2022	2023.01	08/02/2022 04:48:58 PM Eastern Daylight Time	08/03/2022 08:28:12 AM Eastern Daylight Time	07/31/2022 08:53:52 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	009	0	2023	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	4	1			2			08/02/2022	2023.01	08/02/2022 04:49:50 PM Eastern Daylight Time	08/03/2022 08:29:07 AM Eastern Daylight Time	07/31/2022 08:54:18 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	010	0	2023	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	4	1			2			08/02/2022	2023.01	08/02/2022 04:51:02 PM Eastern Daylight Time	08/03/2022 08:30:02 AM Eastern Daylight Time	07/31/2022 08:54:44 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	01	01		1			H0628	011	0	2023	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	5	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 11:05:34 AM Eastern Daylight Time	08/03/2022 08:30:59 AM Eastern Daylight Time	07/31/2022 08:55:10 PM Eastern Daylight Time			08/05/2022 11:54:42 AM 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	2023	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	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 08:10:13 PM Eastern Daylight Time	08/03/2022 08:31:56 AM Eastern Daylight Time	07/31/2022 08:55:36 PM Eastern Daylight Time			08/05/2022 11:54:42 AM 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	2023	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	05/31/2022	2023.01	05/31/2022 05:42:35 PM Eastern Daylight Time	06/01/2022 01:17:23 PM Eastern Daylight Time				06/02/2022 12:30:34 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO)	01	01		1			H0628	014	0	2023	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	05/31/2022	2023.01	05/31/2022 05:47:34 PM Eastern Daylight Time	06/01/2022 01:18:17 PM Eastern Daylight Time				06/02/2022 12:30:34 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO)	01	01		1			H0628	015	0	2023	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			08/02/2022	2023.01	08/02/2022 04:52:52 PM Eastern Daylight Time	08/03/2022 08:34:44 AM Eastern Daylight Time	07/31/2022 08:56:04 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	017	0	2023	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	05/31/2022	2023.01	05/31/2022 03:55:13 PM Eastern Daylight Time					06/02/2022 02:37:20 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H0628	801	0	2023	Ohio		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H0628	802	0	1	01	01	H0628_802_0	1	1						05/31/2022	2023.01	05/31/2022 03:56:47 PM Eastern Daylight Time					06/02/2022 02:39:01 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	2023	Ohio		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H0630	013	0	1	01	01	H0630_013_0	8	1						08/02/2022	2023.01	08/02/2022 12:19:51 PM Mountain Daylight Time	08/03/2022 10:37:18 AM Mountain Daylight Time	08/03/2022 10:21:03 AM Mountain Daylight Time			08/04/2022 04:00:49 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core DM (HMO)	01	01		1			H0630	013	0	2023	Denver Metro Area		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(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	06/01/2022	2023.01	06/01/2022 11:53:44 AM Mountain Daylight Time	08/03/2022 10:37:40 AM Mountain Daylight Time	08/03/2022 10:22:07 AM Mountain Daylight Time			08/04/2022 04:00:49 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	2023	Denver Metro Area		2		2			1	3		2					2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	015	0	1	02	01	H0630_015_0	9	1						08/02/2022	2023.01	08/02/2022 12:21:53 PM Mountain Daylight Time	08/03/2022 10:38:26 AM Mountain Daylight Time	08/03/2022 10:23:11 AM Mountain Daylight Time			08/04/2022 04:00:49 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver DM (HMO-POS)	01	02		1			H0630	015	0	2023	Denver Metro Area		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	016	0	1	02	01	H0630_016_0	9	1						08/02/2022	2023.01	08/02/2022 12:23:15 PM Mountain Daylight Time	08/03/2022 10:38:48 AM Mountain Daylight Time	08/03/2022 10:24:14 AM Mountain Daylight Time			08/04/2022 04:00:49 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Gold (HMO-POS)	01	02		1			H0630	016	0	2023	Denver Metro Area		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	017	0	1	01	01	H0630_017_0	8	1						08/03/2022	2023.01	08/03/2022 09:19:26 AM Mountain Daylight Time	08/03/2022 10:39:35 AM Mountain Daylight Time	08/03/2022 10:25:17 AM Mountain Daylight Time			08/04/2022 04:00:49 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core South (HMO)	01	01		1			H0630	017	0	2023	Southern Colorado		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(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						08/02/2022	2023.01	08/02/2022 12:44:46 PM Mountain Daylight Time	08/03/2022 10:39:56 AM Mountain Daylight Time	08/03/2022 10:26:24 AM Mountain Daylight Time			08/04/2022 04:00:49 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core North (HMO)	01	01		1			H0630	020	0	2023	Northern Colorado		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	021	0	1	02	01	H0630_021_0	9	1						08/02/2022	2023.01	08/02/2022 12:44:15 PM Mountain Daylight Time	08/03/2022 10:40:45 AM Mountain Daylight Time	08/03/2022 10:27:28 AM Mountain Daylight Time			08/04/2022 04:00:49 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver North (HMO-POS)	01	02		1			H0630	021	0	2023	Northern Colorado		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	023	0	1	02	01	H0630_023_0	8	1						08/02/2022	2023.01	08/02/2022 12:43:16 PM Mountain Daylight Time	08/03/2022 10:41:07 AM Mountain Daylight Time	08/03/2022 10:28:33 AM Mountain Daylight Time			08/04/2022 04:00:49 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO-POS)	01	02		1			H0630	023	0	2023	Southern Colorado		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(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	06/01/2022	2023.01	06/01/2022 11:54:35 AM Mountain Daylight Time	08/03/2022 10:41:53 AM Mountain Daylight Time	08/03/2022 10:29:37 AM Mountain Daylight Time			08/04/2022 04:00:49 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	2023	Southern Colorado - Pueblo County		2		2			1	3		2					2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	025	0	1	02	01	H0630_025_0	8	1						08/02/2022	2023.01	08/02/2022 12:41:42 PM Mountain Daylight Time	08/03/2022 10:42:14 AM Mountain Daylight Time	08/03/2022 10:30:41 AM Mountain Daylight Time			08/04/2022 04:00:49 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Bronze DM (HMO-POS)	01	02		1			H0630	025	0	2023	Denver Metro Area		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	026	0	1	02	01	H0630_026_0	8	1						08/02/2022	2023.01	08/02/2022 12:41:20 PM Mountain Daylight Time	08/03/2022 10:43:01 AM Mountain Daylight Time	08/03/2022 10:31:44 AM Mountain Daylight Time			08/04/2022 04:00:49 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Bronze North (HMO-POS)	01	02		1			H0630	026	0	2023	Northern Colorado		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(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	7	1						05/24/2022	2023.01	05/24/2022 04:58:12 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Denver Metro Area		1	9162	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;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	7	1				0	0	05/27/2022	2023.01	05/27/2022 09:40:08 AM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Denver Metro Area		1	0	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7k;8a;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	7	1						05/24/2022	2023.01	05/24/2022 04:59:32 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Denver Metro Area		1	245536	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;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	7	1				0	0	05/24/2022	2023.01	05/24/2022 04:59:42 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Denver Metro Area		1	0	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7k;8a;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	7	1						05/24/2022	2023.01	05/24/2022 04:59:54 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Denver Metro Area		1	45	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;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	7	1						05/24/2022	2023.01	05/24/2022 05:00:05 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Denver Metro Area		1	36076	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;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	7	1						05/24/2022	2023.01	05/24/2022 04:58:29 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Southern Colorado		1	1836	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1				0	0	05/23/2022	2023.01	05/23/2022 05:09:05 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Southern Colorado		1	0	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1						05/27/2022	2023.01	05/27/2022 09:40:20 AM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Southern Colorado		1	29780	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1				0	0	05/23/2022	2023.01	05/23/2022 05:08:43 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Southern Colorado		1	0	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1						05/23/2022	2023.01	05/23/2022 05:08:35 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Southern Colorado		1	0	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1						05/23/2022	2023.01	05/23/2022 05:08:26 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Southern Colorado		1	5615	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1						05/23/2022	2023.01	05/23/2022 05:08:15 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Northern Colorado		1	406	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1				0	0	05/23/2022	2023.01	05/23/2022 04:37:08 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Northern Colorado		1	0	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1						05/23/2022	2023.01	05/23/2022 04:37:19 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Northern Colorado		1	12243	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1				0	0	05/23/2022	2023.01	05/23/2022 04:37:32 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Northern Colorado		1	0	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1						05/23/2022	2023.01	05/23/2022 04:37:41 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Northern Colorado		1	0	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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	7	1						05/23/2022	2023.01	05/23/2022 04:37:52 PM Mountain Daylight Time					06/06/2022 07:30:13 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	2023	Northern Colorado		1	1848	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(800)476-2167		(800)476-2167		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;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			2		1	08/02/2022	2023.01	08/02/2022 06:08:59 PM Central Daylight Time	08/02/2022 10:58:45 AM Central Daylight Time	08/01/2022 10:18:00 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H0672	001	0	2023	Denver		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	003	0	1	01	01	H0672_003_0	6	1			2		1	08/02/2022	2023.01	08/02/2022 06:48:22 PM Central Daylight Time	08/02/2022 11:00:42 AM Central Daylight Time	08/01/2022 10:18:32 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H0672	003	0	2023	Fort Collins		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	004	0	1	01	01	H0672_004_0	6	1			2		1	08/02/2022	2023.01	08/02/2022 06:49:36 PM Central Daylight Time	08/02/2022 11:08:08 AM Central Daylight Time	08/01/2022 10:19:04 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H0672	004	0	2023	Colorado Springs		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	005	0	1	01	01	H0672_005_0	6	1			2		1	08/02/2022	2023.01	08/02/2022 06:50:13 PM Central Daylight Time	08/02/2022 11:10:35 AM Central Daylight Time	08/01/2022 10:19:35 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H0672	005	0	2023	Albuquerque		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)333-7640		(866)333-7640		(800)668-3813		(800)668-3813		(866)333-7640		(866)333-7640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	006	0	1	01	01	H0672_006_0	6	1			2		1	08/02/2022	2023.01	08/02/2022 07:28:22 PM Central Daylight Time	08/03/2022 04:50:42 PM Central Daylight Time	08/01/2022 10:20:08 AM Central Daylight Time			08/04/2022 04:14:31 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	006	0	2023	Cleveland/Youngston		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			2		1	08/02/2022	2023.01	08/02/2022 06:53:40 PM Central Daylight Time	08/02/2022 11:19:12 AM Central Daylight Time	08/01/2022 10:20:40 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	007	0	2023	Colorado SW Corner		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	008	0	1	01	01	H0672_008_0	6	1			2		1	08/02/2022	2023.01	08/02/2022 06:58:33 PM Central Daylight Time	08/02/2022 11:21:34 AM Central Daylight Time	08/01/2022 10:21:12 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	008	0	2023	Colorado Western Slope		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	009	0	1	01	01	H0672_009_0	5	1	2	1	1		0	05/23/2022	2023.01	05/23/2022 10:18:14 AM Central Daylight Time	08/02/2022 11:23:26 AM Central Daylight Time	08/01/2022 10:21:45 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H0672	009	0	2023	Colorado		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	010	0	1	01	01	H0672_010_0	5	1	2	1	1		0	05/22/2022	2023.01	05/22/2022 08:08:19 PM Central Daylight Time	08/02/2022 11:24:44 AM Central Daylight Time	08/01/2022 10:22:18 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H0672	010	0	2023	Colorado		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	011	0	1	01	01	H0672_011_0	5	1			2		1	05/31/2022	2023.01	05/31/2022 07:07:49 PM Central Daylight Time	08/02/2022 05:57:45 PM Central Daylight Time	08/01/2022 10:22:49 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H0672	011	0	2023	Cleveland/Youngston		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	012	0	1	01	01	H0672_012_0	6	1	2	1	1		0	07/18/2022	2023.01	07/18/2022 02:19:03 PM Central Daylight Time	08/02/2022 05:55:58 PM Central Daylight Time	08/01/2022 10:23:23 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H0672	012	0	2023	Cleveland/Youngston		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	013	0	1	01	01	H0672_013_0	6	1			2		1	08/02/2022	2023.01	08/02/2022 07:28:53 PM Central Daylight Time	08/03/2022 04:52:21 PM Central Daylight Time	08/01/2022 10:23:55 AM Central Daylight Time			08/04/2022 04:14:31 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	013	0	2023	Dayton/Cincinnati		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	014	0	1	01	01	H0672_014_0	5	1			2		1	05/31/2022	2023.01	05/31/2022 07:08:13 PM Central Daylight Time	08/02/2022 06:01:26 PM Central Daylight Time	08/01/2022 10:24:26 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H0672	014	0	2023	Dayton/Cincinnati		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	015	0	1	01	01	H0672_015_0	6	1	2	1	1		0	07/18/2022	2023.01	07/18/2022 02:19:27 PM Central Daylight Time	08/02/2022 06:04:40 PM Central Daylight Time	08/01/2022 10:25:00 AM Central Daylight Time			08/04/2022 01:44:57 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H0672	015	0	2023	Dayton/Cincinnati		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	016	0	1	01	01	H0672_016_0	6	1			2		1	08/02/2022	2023.01	08/02/2022 07:29:26 PM Central Daylight Time	08/03/2022 04:53:48 PM Central Daylight Time	08/01/2022 10:25:31 AM Central Daylight Time			08/04/2022 04:14:31 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H0672	016	0	2023	Cleveland/Youngston		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	017	0	1	01	01	H0672_017_0	6	1			2		1	08/02/2022	2023.01	08/02/2022 07:29:46 PM Central Daylight Time	08/03/2022 04:57:22 PM Central Daylight Time	08/01/2022 10:26:02 AM Central Daylight Time			08/04/2022 04:14:31 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H0672	017	0	2023	Dayton/Cincinnati		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	801	0	1	01	01	H0672_801_0	3	1						05/22/2022	2023.01	05/22/2022 05:25:18 PM Central Daylight Time					06/02/2022 07:50:30 AM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	801	0	2023	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	08/15/2022	2023.01	08/15/2022 10:58:12 AM Central Daylight Time	08/03/2022 11:12:34 AM Central Daylight Time	07/31/2022 12:09:23 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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				08/15/2022	2023.01	08/15/2022 10:58:23 AM Central Daylight Time	08/03/2022 11:13:52 AM Central Daylight Time	07/31/2022 12:09:47 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Select counties in AZ		2		2			1	1	1							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)370-2843		(877)370-2843		(888)834-3721		(888)834-3721		(877)370-2843		(877)370-2843		(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	2	1		1			0	08/02/2022	2023.01	08/02/2022 04:06:43 PM Central Daylight Time	08/03/2022 11:15:12 AM Central Daylight Time	07/31/2022 12:10:12 AM Central Daylight Time			08/04/2022 02:44:59 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	2023	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	08/15/2022	2023.01	08/15/2022 10:59:45 AM Central Daylight Time	08/03/2022 11:16:31 AM Central Daylight Time	07/31/2022 12:10:36 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 10:59:56 AM Central Daylight Time	08/03/2022 11:17:51 AM Central Daylight Time	07/31/2022 12:11:00 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Fairfield and Hartford 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	08/15/2022	2023.01	08/15/2022 11:00:06 AM Central Daylight Time	08/03/2022 11:19:11 AM Central Daylight Time	07/31/2022 12:11:25 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:00:17 AM Central Daylight Time	08/03/2022 11:20:32 AM Central Daylight Time	07/31/2022 12:11:48 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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				08/15/2022	2023.01	08/15/2022 11:00:29 AM Central Daylight Time	08/03/2022 11:21:53 AM Central Daylight Time	07/31/2022 12:12:13 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	016	0	1	04	01	H0710_016_0	3	1		1				08/15/2022	2023.01	08/15/2022 11:00:40 AM Central Daylight Time	08/03/2022 11:23:13 AM Central Daylight Time	07/31/2022 12:12:37 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:00:49 AM Central Daylight Time	08/03/2022 11:24:35 AM Central Daylight Time	07/31/2022 12:13:02 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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				08/15/2022	2023.01	08/15/2022 11:00:59 AM Central Daylight Time	08/03/2022 11:25:55 AM Central Daylight Time	07/31/2022 12:13:26 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:01:09 AM Central Daylight Time	08/03/2022 11:27:16 AM Central Daylight Time	07/31/2022 12:13:51 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Select Counties in CT, NJ, ME and NH		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				08/15/2022	2023.01	08/15/2022 11:01:19 AM Central Daylight Time	08/03/2022 11:28:36 AM Central Daylight Time	07/31/2022 12:14:15 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:01:28 AM Central Daylight Time	08/03/2022 11:29:56 AM Central Daylight Time	07/31/2022 12:14:39 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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				08/15/2022	2023.01	08/15/2022 11:01:38 AM Central Daylight Time	08/03/2022 11:31:16 AM Central Daylight Time	07/31/2022 12:15:03 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:01:51 AM Central Daylight Time	08/03/2022 11:32:43 AM Central Daylight Time	07/31/2022 12:15:28 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:02:02 AM Central Daylight Time	08/03/2022 11:34:04 AM Central Daylight Time	07/31/2022 12:15:52 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:02:11 AM Central Daylight Time	08/03/2022 11:35:22 AM Central Daylight Time	07/31/2022 12:16:16 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Select Counties in North Carolina		2		2			1	1	1							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	035	0	1	04	01	H0710_035_0	3	1		1				08/15/2022	2023.01	08/15/2022 11:02:21 AM Central Daylight Time	08/03/2022 11:36:42 AM Central Daylight Time	07/31/2022 12:16:41 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	3	1		1			0	08/15/2022	2023.01	08/15/2022 11:02:31 AM Central Daylight Time	08/03/2022 11:38:03 AM Central Daylight Time	07/31/2022 12:17:06 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Select Counties in Oregon		2		2			1	1	1							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	037	0	1	04	01	H0710_037_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:02:40 AM Central Daylight Time	08/03/2022 11:39:22 AM Central Daylight Time	07/31/2022 12:17:30 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Select Counties in Oregon		2		2			1	1	2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	038	0	1	04	01	H0710_038_0	3	1		1				08/15/2022	2023.01	08/15/2022 11:02:50 AM Central Daylight Time	08/03/2022 11:40:41 AM Central Daylight Time	07/31/2022 12:17:54 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Hillsborough County		2		2			1	1	1							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	039	0	1	04	01	H0710_039_0	3	1		1				08/15/2022	2023.01	08/15/2022 11:03:01 AM Central Daylight Time	08/03/2022 11:42:01 AM Central Daylight Time	07/31/2022 12:18:18 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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				08/15/2022	2023.01	08/15/2022 11:03:16 AM Central Daylight Time	08/03/2022 11:43:20 AM Central Daylight Time	07/31/2022 12:18:42 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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				08/15/2022	2023.01	08/15/2022 11:03:27 AM Central Daylight Time	08/03/2022 11:44:39 AM Central Daylight Time	07/31/2022 12:19:07 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:03:36 AM Central Daylight Time	08/03/2022 11:45:59 AM Central Daylight Time	07/31/2022 12:19:31 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:03:45 AM Central Daylight Time	08/03/2022 11:47:18 AM Central Daylight Time	07/31/2022 12:19:55 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Kent, Providence, and Washington 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	051	0	1	04	01	H0710_051_0	3	1		1				08/15/2022	2023.01	08/15/2022 11:03:55 AM Central Daylight Time	08/03/2022 11:48:38 AM Central Daylight Time	07/31/2022 12:20:19 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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				08/15/2022	2023.01	08/15/2022 11:04:04 AM Central Daylight Time	08/03/2022 11:49:57 AM Central Daylight Time	07/31/2022 12:20:43 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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				08/15/2022	2023.01	08/15/2022 11:04:13 AM Central Daylight Time	08/03/2022 11:51:15 AM Central Daylight Time	07/31/2022 12:21:08 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:04:22 AM Central Daylight Time	08/03/2022 11:52:34 AM Central Daylight Time	07/31/2022 12:21:31 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:04:32 AM Central Daylight Time	08/03/2022 11:53:48 AM Central Daylight Time	07/31/2022 12:21:55 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Cook, Du Page, and Lake 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	056	0	1	04	01	H0710_056_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:04:41 AM Central Daylight Time	08/03/2022 11:55:05 AM Central Daylight Time	07/31/2022 12:22:19 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:04:50 AM Central Daylight Time	08/03/2022 11:56:25 AM Central Daylight Time	07/31/2022 12:22:43 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:04:59 AM Central Daylight Time	08/03/2022 11:57:44 AM Central Daylight Time	07/31/2022 12:23:07 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	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	08/15/2022	2023.01	08/15/2022 11:05:08 AM Central Daylight Time	08/03/2022 11:59:05 AM Central Daylight Time	07/31/2022 12:23:31 AM Central Daylight Time			08/15/2022 03:16:00 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	2023	Select Counties in WA		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	060	0	1	04	01	H0710_060_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:05:17 AM Central Daylight Time	08/03/2022 12:00:24 PM Central Daylight Time	07/31/2022 12:23:55 AM Central Daylight Time			08/15/2022 03:16:00 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	060	0	2023	Black Hawk and Scott 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	061	0	1	04	01	H0710_061_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:05:27 AM Central Daylight Time	08/03/2022 12:01:43 PM Central Daylight Time	07/31/2022 12:24:18 AM Central Daylight Time			08/15/2022 03:16:00 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	061	0	2023	Select Counties in Indiana		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	062	0	1	04	01	H0710_062_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:05:36 AM Central Daylight Time	08/03/2022 12:03:02 PM Central Daylight Time	07/31/2022 12:24:43 AM Central Daylight Time			08/15/2022 03:16:00 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	062	0	2023	Johnson County in Kansas		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	063	0	1	04	01	H0710_063_0	4	1		1				08/15/2022	2023.01	08/15/2022 11:05:45 AM Central Daylight Time	08/03/2022 12:04:22 PM Central Daylight Time	07/31/2022 12:25:07 AM Central Daylight Time			08/15/2022 03:16:00 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	063	0	2023	Johnson and Wyandotte 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	064	0	1	04	01	H0710_064_0	4	1		1				08/15/2022	2023.01	08/15/2022 11:05:55 AM Central Daylight Time	08/03/2022 12:05:40 PM Central Daylight Time	07/31/2022 12:25:31 AM Central Daylight Time			08/15/2022 03:16:00 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	064	0	2023	Select Counties in Kentucky		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	065	0	1	04	01	H0710_065_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:06:04 AM Central Daylight Time	08/03/2022 12:07:00 PM Central Daylight Time	07/31/2022 12:25:55 AM Central Daylight Time			08/15/2022 03:16:00 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	065	0	2023	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			
H0710	066	0	1	04	01	H0710_066_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:06:14 AM Central Daylight Time	08/03/2022 12:08:19 PM Central Daylight Time	07/31/2022 12:26:19 AM Central Daylight Time			08/15/2022 03:16:00 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	066	0	2023	Select Counties in Missouri		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	067	0	1	04	01	H0710_067_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:06:23 AM Central Daylight Time	08/03/2022 12:09:42 PM Central Daylight Time	07/31/2022 12:26:43 AM Central Daylight Time			08/15/2022 03:16:00 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	067	0	2023	Select Counties in Pennsylvania		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	068	0	1	04	01	H0710_068_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:06:33 AM Central Daylight Time	08/03/2022 12:11:02 PM Central Daylight Time	07/31/2022 12:27:06 AM Central Daylight Time			08/15/2022 03:16:00 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	068	0	2023	Select Counties in South 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			
H0710	069	0	1	04	01	H0710_069_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:06:44 AM Central Daylight Time	08/03/2022 12:12:23 PM Central Daylight Time	07/31/2022 12:27:30 AM Central Daylight Time			08/15/2022 03:16:00 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	069	0	2023	Select Counties in Utah		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	070	0	1	04	01	H0710_070_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:06:55 AM Central Daylight Time	08/03/2022 12:13:48 PM Central Daylight Time	07/31/2022 12:27:54 AM Central Daylight Time			08/15/2022 03:16:00 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	070	0	2023	Select Counties in AL, MS and TN		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						06/03/2022	2023.01	06/03/2022 09:24:23 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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	06/03/2022	2023.01	06/03/2022 09:25:20 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:34:54 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:35:17 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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	06/03/2022	2023.01	06/03/2022 09:35:37 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:35:55 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:36:15 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:38:41 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:39:01 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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	06/03/2022	2023.01	06/03/2022 09:39:22 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:39:41 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:39:58 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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	06/03/2022	2023.01	06/03/2022 09:40:16 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:40:34 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:40:52 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:42:25 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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	06/03/2022	2023.01	06/03/2022 09:42:43 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:43:04 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:43:24 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:43:43 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:44:03 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:44:20 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:44:38 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:44:57 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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	06/03/2022	2023.01	06/03/2022 09:45:26 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:45:44 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:46:05 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:46:29 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:46:49 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 09:47:07 AM Central Daylight Time					06/03/2022 02:52:30 PM 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	2023	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	5	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 02:05:00 PM Eastern Daylight Time	08/03/2022 06:28:58 PM Central Daylight Time	07/30/2022 06:37:05 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H0712	005	0	2023	All counties in CT		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:06:03 PM Eastern Daylight Time	08/03/2022 06:30:19 PM Central Daylight Time	07/30/2022 06:37:35 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H0712	019	0	2023	All counties in CT		2		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	4	1						05/25/2022	2023.01	05/25/2022 07:17:30 PM Central Daylight Time	08/03/2022 06:31:36 PM Central Daylight Time	07/30/2022 06:38:10 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H0712	020	0	2023	All counties in CT		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:14:09 PM Eastern Daylight Time	08/03/2022 08:07:36 PM Eastern Daylight Time	07/30/2022 07:38:44 AM Eastern Daylight Time			08/04/2022 05:27:00 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Value (HMO)	01	01		1			H0712	023	0	2023	Select counties in NC		2		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	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 01:45:15 PM Eastern Daylight Time	08/03/2022 08:08:47 PM Eastern Daylight Time	07/30/2022 07:39:17 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NC		2		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	1		0	07/05/2022	2023.01	07/05/2022 11:43:45 AM Central Daylight Time	08/03/2022 06:32:51 PM Central Daylight Time	07/30/2022 06:39:49 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H0712	029	0	2023	All counties in CT		2		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			
H0724	001	0	1	01	01	H0724_001_0	6	1						08/01/2022	2023.01	08/01/2022 12:03:54 PM Eastern Daylight Time	08/03/2022 07:33:48 PM Eastern Daylight Time	07/30/2022 07:40:20 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	2			
H0724	006	0	1	01	01	H0724_006_0	6	1						05/26/2022	2023.01	05/26/2022 07:09:50 AM Eastern Daylight Time	08/03/2022 07:35:18 PM Eastern Daylight Time	07/30/2022 07:40:51 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	2			
H0724	007	0	1	01	01	H0724_007_0	6	1						08/01/2022	2023.01	08/01/2022 12:18:03 PM Eastern Daylight Time	08/03/2022 07:38:04 PM Eastern Daylight Time	07/30/2022 07:41:22 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	2			
H0724	801	0	1	01	01	H0724_801_0	1	1						05/10/2022	2023.01	05/10/2022 09:50:31 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	Countywide		1	100	2			2									allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:50:37 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	Countywide		1	100	2			2									allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 09:50:44 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	Countywide		1	100	2			2									allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H0738	001	0	1	01	01	H0738_001_0	6	1	2	1			0	08/03/2022	2023.01	08/03/2022 02:17:26 PM Eastern Daylight Time	08/04/2022 11:08:03 AM Eastern Daylight Time	08/04/2022 11:08:03 AM Eastern Daylight Time			08/04/2022 11:14:44 AM Eastern Daylight Time	AmeriHealth Caritas VIP Next, Inc.	AmeriHealth Caritas VIP Care	www.amerihealthcaritasvipcare.com	AmeriHealth Caritas VIP Care (HMO D-SNP)	01	01		1			H0738	001	0	2023	Statewide		2		2			1	3		1					1	www.amerihealthcaritasvipcare.com	www.amerihealthcaritasvipcare.com	www.amerihealthcaritasvipcare.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			
H0755	030	0	1	02	01	H0755_030_0	2	1					1	06/01/2022	2023.01	06/01/2022 09:03:20 PM Central Daylight Time	08/03/2022 11:34:00 AM Central Daylight Time	07/31/2022 12:28:18 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H0755	030	0	2023	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	02	01	H0755_031_0	2	1					1	06/01/2022	2023.01	06/01/2022 09:05:13 PM Central Daylight Time	08/03/2022 11:34:44 AM Central Daylight Time	07/31/2022 12:28:42 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H0755	031	0	2023	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	02	01	H0755_032_0	1	1				0	0	06/01/2022	2023.01	06/01/2022 09:05:38 PM Central Daylight Time	06/01/2022 11:08:24 AM Central Daylight Time				06/02/2022 02:17:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Patriot (HMO-POS)	01	02		1			H0755	032	0	2023	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	02	01	H0755_033_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:06:27 AM Central Daylight Time	08/03/2022 11:35:29 AM Central Daylight Time	07/31/2022 12:29:06 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Plan 3 (HMO-POS)	01	02		1			H0755	033	0	2023	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	02	01	H0755_037_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 02:12:01 PM Central Daylight Time	06/01/2022 11:09:40 AM Central Daylight Time				06/02/2022 02:15:26 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H0755	037	0	2023	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	02	01	H0755_038_0	2	1					1	08/04/2022	2023.01	08/04/2022 12:29:50 PM Central Daylight Time	08/03/2022 11:36:14 AM Central Daylight Time	07/31/2022 12:29:30 AM Central Daylight Time			08/04/2022 04:10:06 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H0755	038	0	2023	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	02	01	H0755_044_0	2	1					1	08/04/2022	2023.01	08/04/2022 01:46:39 PM Central Daylight Time	08/03/2022 11:37:00 AM Central Daylight Time	07/31/2022 12:29:54 AM Central Daylight Time			08/04/2022 04:10:06 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H0755	044	0	2023	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	02	01	H0755_045_0	2	1					1	08/02/2022	2023.01	08/02/2022 01:49:53 PM Central Daylight Time	08/03/2022 11:37:46 AM Central Daylight Time	07/31/2022 12:30:18 AM Central Daylight Time			08/04/2022 04:10:06 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO-POS)	01	02		1			H0755	045	0	2023	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						06/03/2022	2023.01	06/03/2022 09:50:24 AM Central Daylight Time					06/03/2022 02:34:33 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	810	0	2023	Connecticut		1	912	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	06/03/2022	2023.01	06/03/2022 09:50:36 AM Central Daylight Time					06/03/2022 02:34:33 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	811	0	2023	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						06/03/2022	2023.01	06/03/2022 09:50:53 AM Central Daylight Time					06/03/2022 02:34:33 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	812	0	2023	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						06/03/2022	2023.01	06/03/2022 09:51:04 AM Central Daylight Time					06/03/2022 02:34:33 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	813	0	2023	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	06/03/2022	2023.01	06/03/2022 09:51:17 AM Central Daylight Time					06/03/2022 02:34:33 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	814	0	2023	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						06/03/2022	2023.01	06/03/2022 09:51:31 AM Central Daylight Time					06/03/2022 02:34:33 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	815	0	2023	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				
H0764	001	0	1	04	01	H0764_001_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 11:12:53 AM Central Daylight Time	08/03/2022 12:17:37 PM Central Daylight Time	07/31/2022 12:30:43 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0764	001	0	2023	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			
H0783	002	0	1	01	01	H0783_002_0	3	1					1	08/03/2022	2023.01	08/03/2022 11:06:10 AM Eastern Daylight Time	08/03/2022 03:52:28 PM Eastern Daylight Time	07/30/2022 05:23:20 AM Eastern Daylight Time			08/04/2022 01:09:42 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	2023	Cameron, Hidalgo and Willacy counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0783	003	0	1	01	01	H0783_003_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:08:02 PM Eastern Daylight Time	08/03/2022 03:52:55 PM Eastern Daylight Time	07/30/2022 05:23:44 AM Eastern Daylight Time			08/04/2022 01:09:42 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF TEXAS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0783-003 (HMO)	01	01		1			H0783	003	0	2023	Brazos, Burleson, Grimes and Washington counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1					1	08/04/2022	2023.01	08/04/2022 09:22:07 AM Central Daylight Time	08/04/2022 02:09:22 PM Central Daylight Time	08/04/2022 02:05:47 PM Central Daylight Time			08/04/2022 03:21:14 PM Central Daylight Time	MEDICA COMMUNITY HEALTH PLAN	Medica	medica.com	Medica Advantage Solution with CHI Health (HMO)	01	01		1			H0798	001	0	2023	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	1	01	4b;	
H0809	001	0	1	20	08	H0809_001_0	1	1						06/01/2022	2023.01	06/01/2022 01:08:03 PM Eastern Daylight Time		06/01/2022 12:41:51 PM Eastern Daylight Time			06/01/2022 01:11:16 PM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mymercylife.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	001	0	2023	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						06/01/2022	2023.01	06/01/2022 01:09:18 PM Eastern Daylight Time		06/01/2022 12:42:07 PM Eastern Daylight Time			06/01/2022 01:11:16 PM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mymercylife.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	002	0	2023	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						05/26/2022	2023.01	05/26/2022 10:31:34 AM Eastern Daylight Time		05/27/2022 10:18:00 AM Eastern Daylight Time			05/27/2022 10:22:23 AM Eastern Daylight Time	SENIOR LIFE YORK, INC.	Senior LIFE York	www.seniorlifepa.com	Senior LIFE York & Harrisburg Dual Eligibile (PACE)	08	20		1			H0819	001	0	2023	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						05/26/2022	2023.01	05/26/2022 10:31:43 AM Eastern Daylight Time		05/27/2022 10:18:00 AM Eastern Daylight Time			05/27/2022 10:22:23 AM Eastern Daylight Time	SENIOR LIFE YORK, INC.	Senior LIFE York	http://www.seniorlifeyork.com	Senior LIFE York & Harrisburg Medicare Only (PACE)	08	20		1			H0819	002	0	2023	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					1	08/04/2022	2023.01	08/04/2022 05:38:17 PM Central Daylight Time	08/04/2022 10:54:56 AM Central Daylight Time	08/03/2022 05:59:11 PM Central Daylight Time			08/05/2022 01:00:10 PM Central 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	2023	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		(800)942-2931		(559)400-6426		(888)807-1308		(559)400-6427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0826	002	0	1	01	01	H0826_002_0	4	1					0	08/04/2022	2023.01	08/04/2022 05:39:06 PM Central Daylight Time	08/04/2022 11:02:57 AM Central Daylight Time	08/03/2022 06:00:06 PM Central Daylight Time			08/05/2022 01:00:10 PM Central Daylight Time	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Innovative Integrated Health Community Plans	www.iihcplans.com	IIHCP Attentive Care (HMO)	01	01		1			H0826	002	0	2023	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		(800)942-2931		(559)400-6426		(888)807-1308		(559)400-6427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	024	0	1	01	01	H0838_024_0	6	1	2	1	2		0	08/03/2022	2023.01	08/03/2022 05:37:16 PM Central Daylight Time	08/04/2022 02:30:02 PM Central Daylight Time	08/04/2022 02:30:18 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Select counties in Central and Southern CA		2		2			1	3		1					1	www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	028	0	1	01	01	H0838_028_0	6	1		1	2		0	08/03/2022	2023.01	08/03/2022 05:50:10 PM Central Daylight Time	08/04/2022 02:30:02 PM Central Daylight Time	08/04/2022 02:30:18 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Select counties in Central and Southern CA		2		2			1	4			00000100000000000000000					www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	029	0	1	01	01	H0838_029_0	6	1		1	2		0	08/03/2022	2023.01	08/03/2022 05:50:48 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:18 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Select counties in Central and Southern CA		2		2			1	4			00000100000000000000000					www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	039	1	1	01	01	H0838_039_1	6	1		1	2		1	08/03/2022	2023.01	08/03/2022 05:53:26 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Select counties in Central and Southern CA	KER LA ORA RIV SBD SD	2		2			1	4			00000000000000000010000					www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	039	2	1	01	01	H0838_039_2	6	1		1	2		1	08/03/2022	2023.01	08/04/2022 02:38:13 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Select counties in Central and Southern CA	FRE IMP KIN MAD SAC SF SJ SM SCL TUL	2		2			1	4			00000000000000000010000					www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	040	1	1	01	01	H0838_040_1	4	1		1	1		0	08/03/2022	2023.01	08/03/2022 05:58:39 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Select counties in Central and Southern CA	KER LA ORA RIV SBD SD	2		2			1	4			00000000000000000010000					www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	040	2	1	01	01	H0838_040_2	4	1		1	1		0	08/04/2022	2023.01	08/04/2022 02:40:09 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Select counties in Central and Southern CA	FRE IMP KIN SAC SF SJ SM SCL TUL MAD	2		2			1	4			00000000000000000010000					www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	042	0	1	01	01	H0838_042_0	6	1		1	2		0	08/03/2022	2023.01	08/03/2022 06:00:32 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Counties: LA, ORA, RIV, SBD		2		2			1	1	3							www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	043	0	1	01	01	H0838_043_0	6	1		1	2		0	08/03/2022	2023.01	08/03/2022 06:00:51 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	ALA CC FR IM KE KIN MAD SAC SD SF SJ SM SCL TUL YO		2		2			1	1	3							www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	044	0	1	01	01	H0838_044_0	6	1		1	2		0	08/03/2022	2023.01	08/03/2022 06:02:02 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Counties: LA, ORA, RIV, SBD		2		2			1	1	3							www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	045	0	1	01	01	H0838_045_0	6	1		1	2		0	08/03/2022	2023.01	08/03/2022 06:02:21 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	ALA CC FR IM KE KIN MAD SAC SD SF SJ SM SCL TUL YO		2		2			1	1	3							www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	046	0	1	01	01	H0838_046_0	6	1			2		0	08/03/2022	2023.01	08/03/2022 06:07:02 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	Contra Costa and Solano Counties		2		2			2									www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	047	0	1	01	01	H0838_047_0	6	1		1	2		1	08/03/2022	2023.01	08/03/2022 06:07:14 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	047	0	2023	Contra Costa and Solano Counties		2		2			1	4			00000000000000000010000					www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	048	0	1	01	01	H0838_048_0	5	1			2	0	0	05/26/2022	2023.01	05/26/2022 04:33:39 PM Central Daylight Time	06/06/2022 06:30:59 PM Central Daylight Time				06/06/2022 06:57:27 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	2023	Select counties in Central and Southern CA		2		2			2									www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0838	049	0	1	01	01	H0838_049_0	7	1			2		0	08/03/2022	2023.01	08/03/2022 06:08:36 PM Central Daylight Time	08/04/2022 02:30:03 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	2023	LA ORA RIV SBD SD		2		2			2									www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	050	1	1	01	01	H0838_050_1	6	1			2		0	08/03/2022	2023.01	08/03/2022 06:13:48 PM Central Daylight Time	08/04/2022 02:30:04 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	050	1	2023	Select counties in Central and Southern CA	Kern, LA, Orange, Riverside, SBD, SD	2		2			2									www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	050	2	1	01	01	H0838_050_2	6	1			2		0	08/03/2022	2023.01	08/03/2022 06:14:36 PM Central Daylight Time	08/04/2022 02:30:04 PM Central Daylight Time	08/04/2022 02:30:19 PM Central Daylight Time			08/04/2022 02:58:40 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	050	2	2023	Select counties in Central and Southern CA	Central CA and Imperial County	2		2			2									www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	051	1	1	01	01	H0838_051_1	6	1			2		0	08/03/2022	2023.01	08/03/2022 06:14:50 PM Central Daylight Time	08/04/2022 02:30:04 PM Central Daylight Time	08/04/2022 02:30:20 PM Central Daylight Time			08/04/2022 02:58:40 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	051	1	2023	All Brand New Day Approved Counties	Central CA and Imperial County	2		2			2									www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	051	2	1	01	01	H0838_051_2	7	1			2		0	08/03/2022	2023.01	08/04/2022 02:42:42 PM Central Daylight Time	08/04/2022 02:30:04 PM Central Daylight Time	08/04/2022 02:30:20 PM Central Daylight Time			08/04/2022 02:58:40 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	051	2	2023	All Brand New Day Approved Counties	Kern, LA, Orange, Riverside, SB, SD	2		2			2									www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(866)255-4795		(866)255-4795		(888)683-1882		(888)683-1882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0839	001	0	1	20	08	H0839_001_0	1	1						05/10/2022	2023.01	05/10/2022 10:34:56 AM Mountain Daylight Time		06/01/2022 10:31:18 AM Mountain Daylight Time			06/01/2022 11:28:13 AM Mountain 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	2023	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						05/10/2022	2023.01	05/10/2022 10:35:36 AM Mountain Daylight Time		06/01/2022 10:35:36 AM Mountain Daylight Time			06/01/2022 11:28:13 AM Mountain 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	2023	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	5	1	2	1	1		0	08/05/2022	2023.01	08/05/2022 11:12:37 AM Eastern Daylight Time	08/05/2022 11:07:09 AM Eastern Daylight Time	08/05/2022 11:07:09 AM Eastern Daylight Time			08/05/2022 12:44:30 PM Eastern Daylight Time	Commonwealth Care Alliance Rhode Island, LLC	Commonwealth Care Alliance Rhode Island	commonwealthcarealliance.org/ri/become-a-member	CCA Medicare Maximum (HMO D-SNP)	01	01		1			H0876	001	0	2023	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/	(833)346-9222		(833)346-9222		(866)275-1222		(866)275-1222		(833)346-9222		(833)346-9222		(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	8	1					1	08/04/2022	2023.01	08/04/2022 01:51:28 PM Central Daylight Time	08/03/2022 04:53:41 PM Central Daylight Time	08/03/2022 09:41:08 AM Central Daylight Time			08/04/2022 01:55:34 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Choice (PPO)	01	04		1			H0885	001	0	2023	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	8	1					1	08/03/2022	2023.01	08/03/2022 01:26:04 PM Central Daylight Time	08/03/2022 04:54:05 PM Central Daylight Time	08/02/2022 04:47:16 PM Central Daylight Time			08/04/2022 01:55:34 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Freedom (PPO)	01	04		1			H0885	002	0	2023	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	003	0	1	04	01	H0885_003_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:33:44 PM Central Daylight Time	08/03/2022 04:54:49 PM Central Daylight Time	08/02/2022 04:47:37 PM Central Daylight Time			08/04/2022 01:55:34 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Choice (PPO)	01	04		1			H0885	003	0	2023	Mercer, Morris, Somerset		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	004	0	1	04	01	H0885_004_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:37:57 PM Central Daylight Time	08/03/2022 04:55:35 PM Central Daylight Time	08/02/2022 04:47:59 PM Central Daylight Time			08/04/2022 01:55:34 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Choice (PPO)	01	04		1			H0885	004	0	2023	Hunterdon, Sussex, Warren		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	005	0	1	04	01	H0885_005_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:51:30 PM Central Daylight Time	08/03/2022 04:56:00 PM Central Daylight Time	08/02/2022 04:48:20 PM Central Daylight Time			08/04/2022 01:55:34 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Choice (PPO)	01	04		1			H0885	005	0	2023	Burlington, Camden, Cumberland, Gloucester, Salem		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	006	0	1	04	01	H0885_006_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:54:34 PM Central Daylight Time	08/03/2022 04:56:23 PM Central Daylight Time	08/02/2022 04:48:41 PM Central Daylight Time			08/04/2022 01:55:34 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Choice (PPO)	01	04		1			H0885	006	0	2023	Atlantic & Cape May		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	3	1				0	0	06/02/2022	2023.01	06/02/2022 10:02:32 PM Central Daylight Time					06/06/2022 01:50:41 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Group (PPO)	01	04		1			H0885	801	0	2023	National		1	22063	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	3	1						06/02/2022	2023.01	06/02/2022 10:04:21 PM Central Daylight Time					06/06/2022 01:50:41 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	2023	National		1	8939	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	805	0	1	04	01	H0885_805_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 10:04:32 PM Central Daylight Time					06/06/2022 01:50:41 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven SHBP - 10 (PPO)	01	04		1			H0885	805	0	2023	National		1	240	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	806	0	1	04	01	H0885_806_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 10:05:05 PM Central Daylight Time					06/06/2022 01:50:41 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven SHBP - 15 (PPO)	01	04		1			H0885	806	0	2023	National		1	240	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	807	0	1	04	01	H0885_807_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 10:05:46 PM Central Daylight Time					06/06/2022 01:50:41 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven SEHBP -  10 (PPO)	01	04		1			H0885	807	0	2023	National		1	240	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	808	0	1	04	01	H0885_808_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 10:06:15 PM Central Daylight Time					06/06/2022 01:50:41 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven SEHBP -  15 (PPO)	01	04		1			H0885	808	0	2023	National		1	240	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	809	0	1	04	01	H0885_809_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 10:06:40 PM Central Daylight Time					06/06/2022 01:50:41 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Group (PPO)	01	04		1			H0885	809	0	2023	National		1	240	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	810	0	1	04	01	H0885_810_0	3	1						06/06/2022	2023.01	06/06/2022 01:47:30 PM Central Daylight Time					06/06/2022 01:50:41 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Group w/Rx (PPO)	01	04		1			H0885	810	0	2023	National		1	240	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	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:05:25 PM Venezuela Standard Time	08/04/2022 06:17:35 PM Venezuela Standard Time	08/04/2022 06:31:34 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard Time	AMERIGROUP IOWA, INC.	Amerigroup Iowa	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	01	01		1			H0907	001	0	2023	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	7	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:24:23 AM Eastern Daylight Time	08/03/2022 07:44:31 PM Eastern Daylight Time	07/30/2022 07:41:53 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		2			1	3		1					1	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(866)389-7690		(866)389-7690		(844)917-0175		(844)917-0175		(866)389-7690		(866)389-7690		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0908	003	0	1	01	01	H0908_003_0	6	1			2			08/01/2022	2023.01	08/01/2022 02:00:29 PM Eastern Daylight Time	08/03/2022 07:46:27 PM Eastern Daylight Time	07/30/2022 07:42:25 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	2			
H0908	004	0	1	01	01	H0908_004_0	6	1			2			05/26/2022	2023.01	05/26/2022 07:20:20 AM Eastern Daylight Time	08/03/2022 07:47:41 PM Eastern Daylight Time	07/30/2022 07:42:57 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	2			
H0908	005	0	1	01	01	H0908_005_0	6	1			2			08/01/2022	2023.01	08/01/2022 12:26:39 PM Eastern Daylight Time	08/03/2022 07:48:54 PM Eastern Daylight Time	07/30/2022 07:43:28 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	2			
H0908	801	0	1	01	01	H0908_801_0	1	1						05/10/2022	2023.01	05/10/2022 09:50:54 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0908	801	0	2023	Statewide		1	100	2			2									allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:50:58 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0908	802	0	2023	Statewide		1	100	2			2									allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 09:51:03 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0908	803	0	2023	Statewide		1	100	2			2									allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	4	1						08/03/2022	2023.01	08/03/2022 02:54:45 PM Eastern Daylight Time	08/03/2022 08:09:57 PM Eastern Daylight Time	07/30/2022 07:43:58 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NJ		2		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	5	1	2	1			0	07/19/2022	2023.01	07/19/2022 09:05:31 AM Eastern Daylight Time	08/03/2022 08:11:07 PM Eastern Daylight Time	07/30/2022 07:44:30 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NJ		2		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	4	1						05/25/2022	2023.01	05/25/2022 05:31:00 PM Eastern Daylight Time	08/03/2022 08:12:17 PM Eastern Daylight Time	07/30/2022 07:45:02 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NJ		2		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	4	1						08/01/2022	2023.01	08/01/2022 02:12:35 PM Eastern Daylight Time	08/03/2022 08:13:29 PM Eastern Daylight Time	07/30/2022 07:45:33 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NJ		2		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;7j;	
H0913	020	0	1	01	01	H0913_020_0	3	1				0	0	05/25/2022	2023.01	05/25/2022 05:35:54 PM Eastern Daylight Time	06/03/2022 07:13:55 PM Eastern Daylight Time				07/15/2022 03:46:22 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	2023	Select counties in NJ		2		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			
H0913	021	0	1	01	01	H0913_021_0	4	1						08/03/2022	2023.01	08/03/2022 02:56:33 PM Eastern Daylight Time	08/03/2022 08:14:41 PM Eastern Daylight Time	07/30/2022 07:46:04 AM Eastern Daylight Time			08/04/2022 05:27:00 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0913	021	0	2023	Select Counties in New Jersey		2		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			
H0927	001	0	1	48	05	H0927_001_0	5	1						05/31/2022	2023.01	05/31/2022 04:50:22 PM Central Daylight Time					06/01/2022 10:57:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Community MMAI	www.bcbsil.com/mmai	Blue Medicare Advantage (Medicare-Medicaid Plan)	05	48		1			H0927	001	0	2023	State of IL		2	280052	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		(833)918-4220		(833)918-4220		(877)723-7702		(877)723-7702		(833)918-4220		(833)918-4220		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0934	001	0	1	20	08	H0934_001_0	1	1						05/31/2022	2023.01	05/31/2022 02:08:44 PM Mountain Daylight Time		05/26/2022 12:38:31 PM Mountain Daylight Time			05/31/2022 02:12:07 PM Mountain Daylight Time	PACIFIC PACE, LLC	WelbeHealth Pacific PACE	https://welbehealth.com/locations/	WelbeHealth Pacific PACE (PACE)	08	20		1			H0934	001	0	2023	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						05/31/2022	2023.01	05/31/2022 02:09:26 PM Mountain Daylight Time		05/26/2022 12:38:31 PM Mountain Daylight Time			05/31/2022 02:12:07 PM Mountain Daylight Time	PACIFIC PACE, LLC	WelbeHealth Pacific PACE	https://welbehealth.com/locations/	WelbeHealth Pacific PACE (PACE)	08	20		1			H0934	002	0	2023	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	4	1						08/03/2022	2023.01	08/03/2022 02:47:13 PM Eastern Daylight Time	08/03/2022 08:40:10 PM Eastern Daylight Time	07/30/2022 07:46:35 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NH		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:50:15 PM Eastern Daylight Time	08/03/2022 08:41:21 PM Eastern Daylight Time	07/30/2022 07:47:07 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NH		2		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	3	1				0	0	07/13/2022	2023.01	07/13/2022 05:27:51 PM Eastern Daylight Time	06/03/2022 08:16:46 PM Eastern Daylight Time				07/15/2022 03:46:22 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	2023	Select counties in NH		2		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	4	1						07/14/2022	2023.01	07/14/2022 05:26:35 PM Eastern Daylight Time	08/03/2022 08:42:37 PM Eastern Daylight Time	07/30/2022 07:47:38 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NH		2		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	8	1					1	08/03/2022	2023.01	08/03/2022 01:55:40 PM Pacific Daylight Time	08/03/2022 07:38:34 PM Pacific Daylight Time	08/02/2022 09:56:10 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H0978	001	0	2023	Clark County		2		2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7e1;7e2;7h1;7h2;	
H0978	002	0	1	01	01	H0978_002_0	8	1		1			1	08/03/2022	2023.01	08/03/2022 02:04:54 PM Pacific Daylight Time	08/03/2022 07:39:07 PM Pacific Daylight Time	08/02/2022 09:56:23 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	Clark County		2		2			1	4			00000010000000000000000					www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7e1;7e2;7h1;7h2;	
H0978	003	0	1	01	01	H0978_003_0	8	1		1			1	08/03/2022	2023.01	08/03/2022 02:06:21 PM Pacific Daylight Time	08/03/2022 07:39:39 PM Pacific Daylight Time	08/02/2022 09:56:37 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	Clark County		2		2			1	4			00000000000000010000000					www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7e1;7e2;7h1;7h2;	
H0978	004	0	1	01	01	H0978_004_0	9	1					1	08/03/2022	2023.01	08/03/2022 02:08:09 PM Pacific Daylight Time	08/03/2022 07:40:12 PM Pacific Daylight Time	08/02/2022 09:56:51 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H0978	004	0	2023	Clark County		2		2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;17a;	
H0978	005	0	1	01	01	H0978_005_0	7	1					1	08/03/2022	2023.01	08/03/2022 02:17:03 PM Pacific Daylight Time	08/03/2022 07:40:44 PM Pacific Daylight Time	08/02/2022 09:57:05 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H0978	005	0	2023	Nye County		2		2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	006	0	1	01	01	H0978_006_0	7	1		1			1	08/03/2022	2023.01	08/03/2022 06:06:46 PM Pacific Daylight Time	08/03/2022 07:41:15 PM Pacific Daylight Time	08/02/2022 09:57:19 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H0978	006	0	2023	Nye County		2		2			1	4			00000010000000000000000					www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	007	0	1	01	01	H0978_007_0	7	1		1			1	08/03/2022	2023.01	08/03/2022 06:07:53 PM Pacific Daylight Time	08/03/2022 07:41:46 PM Pacific Daylight Time	08/02/2022 09:57:33 PM Pacific Daylight Time			08/04/2022 06:42:18 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	007	0	2023	Nye County		2		2			1	4			00000000000000010000000					www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	008	0	1	01	01	H0978_008_0	8	1					1	08/03/2022	2023.01	08/03/2022 02:20:20 PM Pacific Daylight Time	08/03/2022 07:42:17 PM Pacific Daylight Time	08/02/2022 09:57:46 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H0978	008	0	2023	Nye County		2		2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	009	0	1	01	01	H0978_009_0	8	1					1	08/10/2022	2023.01	08/10/2022 11:07:38 AM Pacific Daylight Time	08/03/2022 07:42:48 PM Pacific Daylight Time	08/02/2022 09:58:00 PM Pacific Daylight Time			08/10/2022 12:30:52 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Compass (HMO)	01	01		1			H0978	009	0	2023	Clark and Nye Counties		2		2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	802	0	1	01	01	H0978_802_0	6	1						06/03/2022	2023.01	06/03/2022 09:21:17 AM Pacific Daylight Time					06/05/2022 04:42:03 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H0978	802	0	2023	Clark and Nye Counties		1	0	2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	803	0	1	01	01	H0978_803_0	6	1						06/03/2022	2023.01	06/03/2022 09:21:35 AM Pacific Daylight Time					06/05/2022 04:42:03 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H0978	803	0	2023	Clark and Nye Counties		1	0	2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(855)827-7226		(855)827-7226		(855)799-7226		(855)799-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	001	0	1	01	01	H0982_001_0	7	1			2			08/03/2022	2023.01	08/03/2022 02:24:24 PM Eastern Daylight Time	08/03/2022 01:12:47 PM Central Daylight Time	08/03/2022 11:26:54 AM Central Daylight Time			08/04/2022 09:15:33 AM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 001 (HMO)	01	01		1			H0982	001	0	2023	Miami-Dade MAPD		2		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	08/03/2022	2023.01	08/03/2022 02:24:41 PM Eastern Daylight Time	08/03/2022 01:13:27 PM Central Daylight Time	08/03/2022 11:27:13 AM Central Daylight Time			08/04/2022 09:15:33 AM 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	2023	Miami-Dade D-SNP		2		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	7	1			2			08/03/2022	2023.01	08/03/2022 02:26:27 PM Eastern Daylight Time	08/03/2022 01:14:08 PM Central Daylight Time	08/03/2022 11:27:31 AM Central Daylight Time			08/04/2022 09:15:33 AM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 007 (HMO)	01	01		1			H0982	007	0	2023	Broward MAPD		2		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	7	1			2			08/03/2022	2023.01	08/03/2022 02:26:45 PM Eastern Daylight Time	08/03/2022 01:14:49 PM Central Daylight Time	08/03/2022 11:27:49 AM Central Daylight Time			08/04/2022 09:15:33 AM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 008 (HMO)	01	01		1			H0982	008	0	2023	Palm Beach MAPD		2		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	7	1			2			06/05/2022	2023.01	06/05/2022 10:10:00 AM Central Daylight Time	08/04/2022 08:50:34 AM Central Daylight Time	08/03/2022 11:28:06 AM Central Daylight Time			08/04/2022 09:15:33 AM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 009 (HMO)	01	01		1			H0982	009	0	2023	Hillsborough MAPD		2		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	07/05/2022	2023.01	07/05/2022 01:41:41 PM Eastern Daylight Time	08/03/2022 01:16:11 PM Central Daylight Time	08/03/2022 11:28:24 AM Central Daylight Time			08/04/2022 09:15:33 AM 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	2023	Hillsborough D-SNP		2		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	7	1		1	2			08/03/2022	2023.01	08/03/2022 02:25:03 PM Eastern Daylight Time	08/03/2022 01:16:53 PM Central Daylight Time	08/03/2022 11:28:43 AM Central Daylight Time			08/04/2022 09:15:33 AM 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	2023	Miami-Dade C-SNP		2		2			1	4			00000000000010000000000					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	08/03/2022	2023.01	08/03/2022 02:27:28 PM Eastern Daylight Time	08/03/2022 01:17:35 PM Central Daylight Time	08/03/2022 11:29:01 AM Central Daylight Time			08/04/2022 09:15:33 AM 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	2023	Broward D-SNP		2		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	08/03/2022	2023.01	08/03/2022 02:27:40 PM Eastern Daylight Time	08/03/2022 01:18:23 PM Central Daylight Time	08/03/2022 11:29:19 AM Central Daylight Time			08/04/2022 09:15:33 AM 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	2023	Palm Beach D-SNP		2		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	014	0	1	01	01	H0982_014_0	7	1			2			06/05/2022	2023.01	06/05/2022 10:10:43 AM Central Daylight Time	08/03/2022 01:19:22 PM Central Daylight Time	08/03/2022 11:29:36 AM Central Daylight Time			08/04/2022 09:15:33 AM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	Solis SPF 003 (HMO)	01	01		1			H0982	014	0	2023	Miami-Dade HMO		2		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	015	0	1	01	01	H0982_015_0	8	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 01:42:12 PM Eastern Daylight Time	08/03/2022 01:20:12 PM Central Daylight Time	08/03/2022 11:29:55 AM Central Daylight Time			08/04/2022 09:15:33 AM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	Solis SPF 004 (HMO D-SNP)	01	01		1			H0982	015	0	2023	Miami-Dade HMO		2		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	5	1					1	09/16/2022	2023.01	09/16/2022 09:51:56 AM Eastern Daylight Time	08/04/2022 03:13:08 PM Eastern Daylight Time	08/04/2022 04:18:40 PM Eastern Daylight Time			09/16/2022 02:14:52 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	001	0	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 08:36:00 AM Eastern Daylight Time	08/04/2022 03:15:46 PM Eastern Daylight Time	08/04/2022 04:16:44 PM Eastern Daylight Time			08/05/2022 12:13:41 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	021	0	2023	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	023	0	1	01	01	H1016_023_0	4	1					1	08/04/2022	2023.01	08/04/2022 08:38:10 AM Eastern Daylight Time	08/04/2022 03:18:22 PM Eastern Daylight Time	08/04/2022 04:20:52 PM Eastern Daylight Time			08/05/2022 12:13:41 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	01	01		1			H1016	023	0	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 08:40:26 AM Eastern Daylight Time	08/04/2022 03:20:56 PM Eastern Daylight Time	08/04/2022 04:23:00 PM Eastern Daylight Time			08/05/2022 12:13:41 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	01	01		1			H1016	024	0	2023	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	5	1					1	08/04/2022	2023.01	08/04/2022 08:46:30 AM Eastern Daylight Time	08/04/2022 03:23:30 PM Eastern Daylight Time	08/04/2022 04:25:14 PM Eastern Daylight Time			08/05/2022 12:13:41 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Access (HMO-POS)	01	02		1			H1016	025	0	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 08:45:17 AM Eastern Daylight Time	08/04/2022 03:26:06 PM Eastern Daylight Time	08/04/2022 04:28:16 PM Eastern Daylight Time			08/05/2022 12:13:41 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Access (HMO-POS)	01	02		1			H1016	026	0	2023	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	4	1						08/04/2022	2023.01	08/04/2022 11:01:08 AM Eastern Daylight Time	08/04/2022 03:28:40 PM Eastern Daylight Time	08/04/2022 04:30:26 PM Eastern Daylight Time			08/05/2022 12:13:41 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Premium Saver (HMO)	01	01		1			H1016	028	0	2023	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	029	0	1	01	01	H1016_029_0	4	1					1	08/04/2022	2023.01	08/04/2022 09:54:17 AM Eastern Daylight Time	08/04/2022 03:31:14 PM Eastern Daylight Time	08/04/2022 04:32:50 PM Eastern Daylight Time			08/05/2022 12:13:41 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	01	01		1			H1016	029	0	2023	Palm Beach 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	030	0	1	01	01	H1016_030_0	4	1					1	08/04/2022	2023.01	08/04/2022 05:05:59 PM Eastern Daylight Time	08/04/2022 03:33:50 PM Eastern Daylight Time	08/04/2022 04:34:50 PM Eastern Daylight Time			08/05/2022 12:13:41 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	01	01		1			H1016	030	0	2023	Orange, Osceola and Seminole Counties		2		2			2									www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1016	801	0	1	01	01	H1016_801_0	2	1						05/27/2022	2023.01	05/27/2022 09:47:46 AM Eastern Daylight Time					06/06/2022 06:59:20 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Plan (HMO)	01	01		1			H1016	801	0	2023	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	2	1				0	0	05/27/2022	2023.01	05/27/2022 10:10:21 AM Eastern Daylight Time					06/06/2022 06:59:20 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Plan (HMO)	01	01		1			H1016	802	0	2023	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	2	1						05/27/2022	2023.01	05/27/2022 10:25:44 AM Eastern Daylight Time					06/06/2022 06:59:20 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Non-CY Plan (HMO)	01	01		1			H1016	803	0	2023	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	2	1				0	0	05/27/2022	2023.01	05/27/2022 09:31:21 AM Eastern Daylight Time					06/06/2022 06:59:20 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Non-CY Plan (HMO)	01	01		1			H1016	804	0	2023	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	4	1			2		1	08/01/2022	2023.01	08/01/2022 03:11:20 PM Eastern Daylight Time	08/03/2022 04:34:31 PM Eastern Daylight Time	07/30/2022 05:24:08 AM Eastern Daylight Time			08/04/2022 12:02:02 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Plus (HMO)	01	01		1			H1019	001	0	2023	Broward County		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	006	0	1	01	01	H1019_006_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:11:41 PM Eastern Daylight Time	08/03/2022 03:46:37 PM Eastern Daylight Time	07/30/2022 05:24:34 AM Eastern Daylight Time			08/04/2022 12:02:02 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Plus (HMO)	01	01		1			H1019	006	0	2023	Miami-Dade County		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	4	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 10:36:31 AM Eastern Daylight Time	08/03/2022 03:43:12 PM Eastern Daylight Time	07/30/2022 05:24:58 AM Eastern Daylight Time			08/04/2022 12:02:02 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	2023	Broward, Miami-Dade, & Palm Beach Counties		2		2			1	3		2					2	www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	026	0	1	01	01	H1019_026_0	3	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 10:39:59 AM Eastern Daylight Time	08/03/2022 03:44:21 PM Eastern Daylight Time	07/30/2022 05:25:24 AM Eastern Daylight Time			08/04/2022 12:02:02 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	2023	Orlando & Tampa Area		2		2			1	3		2					2	www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1			1		1	08/02/2022	2023.01	08/02/2022 02:09:53 PM Eastern Daylight Time	08/03/2022 03:37:35 PM Eastern Daylight Time	07/30/2022 05:25:48 AM Eastern Daylight Time			08/04/2022 12:02:02 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Plus (HMO)	01	01		1			H1019	043	0	2023	Brevard and Indian River counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1			1		1	08/02/2022	2023.01	08/02/2022 02:10:37 PM Eastern Daylight Time	08/03/2022 03:38:43 PM Eastern Daylight Time	07/30/2022 05:26:12 AM Eastern Daylight Time			08/04/2022 12:02:02 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	2023	Orlando Area		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	08/01/2022	2023.01	08/01/2022 04:43:52 PM Eastern Daylight Time	08/03/2022 03:39:50 PM Eastern Daylight Time	07/30/2022 05:26:38 AM Eastern Daylight Time			08/04/2022 12:02:02 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	065	0	2023	Broward and Palm Beach counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:12:58 PM Eastern Daylight Time	08/03/2022 03:40:57 PM Eastern Daylight Time	07/30/2022 05:27:02 AM Eastern Daylight Time			08/04/2022 12:02:02 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Plus (HMO)	01	01		1			H1019	069	0	2023	Clay, Duval, and St. Johns counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	4	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 07:55:16 PM Eastern Daylight Time	08/03/2022 03:45:30 PM Eastern Daylight Time	07/30/2022 05:27:26 AM Eastern Daylight Time			08/04/2022 12:02:02 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	2023	Atlantic Coast		2		2			1	3		2					2	www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	08/01/2022	2023.01	08/01/2022 03:13:17 PM Eastern Daylight Time	08/03/2022 03:42:07 PM Eastern Daylight Time	07/30/2022 05:27:52 AM Eastern Daylight Time			08/04/2022 12:02:02 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	076	0	2023	Miami-Dade County		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	08/01/2022	2023.01	08/01/2022 03:13:37 PM Eastern Daylight Time	08/03/2022 03:47:42 PM Eastern Daylight Time	07/30/2022 05:28:16 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree Platinum (HMO)	01	01		1			H1019	094	0	2023	Clay, Duval, and St. Johns counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:14:04 PM Eastern Daylight Time	08/03/2022 03:48:47 PM Eastern Daylight Time	07/30/2022 05:28:42 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Plus (HMO)	01	01		1			H1019	098	0	2023	Flagler and Volusia counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	08/01/2022	2023.01	08/01/2022 04:44:10 PM Eastern Daylight Time	08/03/2022 03:49:52 PM Eastern Daylight Time	07/30/2022 05:29:06 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	099	0	2023	Flagler and Volusia counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:44:27 PM Eastern Daylight Time	08/03/2022 03:50:56 PM Eastern Daylight Time	07/30/2022 05:29:30 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Plus (HMO)	01	01		1			H1019	102	0	2023	Palm Beach County		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1			2		1	08/01/2022	2023.01	08/01/2022 04:44:46 PM Eastern Daylight Time	08/03/2022 03:54:16 PM Eastern Daylight Time	07/30/2022 05:29:56 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Plus (HMO)	01	01		1			H1019	103	1	2023	Tampa Area	Polk County	2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:15:23 PM Eastern Daylight Time	08/03/2022 03:55:22 PM Eastern Daylight Time	07/30/2022 05:30:20 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Plus (HMO)	01	01		1			H1019	103	2	2023	Tampa Area	Hernando, Hillsborough, Pasco, & Pinellas counties	2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	08/01/2022	2023.01	08/01/2022 03:15:39 PM Eastern Daylight Time	08/03/2022 05:34:49 PM Eastern Daylight Time	07/30/2022 05:30:46 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	104	1	2023	Tampa Area	Polk County	2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	08/01/2022	2023.01	08/01/2022 03:16:01 PM Eastern Daylight Time	08/03/2022 03:53:08 PM Eastern Daylight Time	07/30/2022 05:31:10 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	104	2	2023	Tampa Area	Hillsborough, Pasco, and Pinellas Counties	2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	4	1		1	2		1	08/01/2022	2023.01	08/01/2022 04:45:21 PM Eastern Daylight Time	08/03/2022 03:56:29 PM Eastern Daylight Time	07/30/2022 05:31:34 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	105	0	2023	Miami-Dade County		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:36:45 PM Eastern Daylight Time	08/03/2022 03:57:35 PM Eastern Daylight Time	07/30/2022 05:31:58 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	106	0	2023	Broward and Palm Beach Counties		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:36:57 PM Eastern Daylight Time	08/03/2022 03:58:43 PM Eastern Daylight Time	07/30/2022 05:32:24 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	107	0	2023	Orlando & Tampa Area		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:37:11 PM Eastern Daylight Time	08/03/2022 03:59:48 PM Eastern Daylight Time	07/30/2022 05:32:48 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete Platinum (HMO C-SNP)	01	01		1			H1019	108	0	2023	Brevard, Flagler, Indian River, & Volusia counties		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:37:25 PM Eastern Daylight Time	08/03/2022 04:05:18 PM Eastern Daylight Time	07/30/2022 05:33:14 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete Platinum (HMO C-SNP)	01	01		1			H1019	109	0	2023	Clay, Duval, and St. Johns counties		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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			1		1	08/01/2022	2023.01	08/01/2022 04:45:37 PM Eastern Daylight Time	08/03/2022 04:00:55 PM Eastern Daylight Time	07/30/2022 05:33:38 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Platinum (HMO-POS)	01	02		1			H1019	110	0	2023	Brevard and Indian River Counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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			1		1	08/01/2022	2023.01	08/01/2022 12:38:11 PM Eastern Daylight Time	08/03/2022 04:02:01 PM Eastern Daylight Time	07/30/2022 05:34:02 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Platinum (HMO)	01	01		1			H1019	111	0	2023	Hillsborough, Pasco, and Pinellas Counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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			1		1	08/01/2022	2023.01	08/01/2022 12:38:25 PM Eastern Daylight Time	08/03/2022 04:03:07 PM Eastern Daylight Time	07/30/2022 05:34:28 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Platinum (HMO)	01	01		1			H1019	112	0	2023	Orlando Area		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:45:53 PM Eastern Daylight Time	08/03/2022 04:04:13 PM Eastern Daylight Time	07/30/2022 05:34:52 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne Platinum (HMO)	01	01		1			H1019	113	0	2023	Clay, Duval, and St. Johns counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	4	1		1	2		1	08/01/2022	2023.01	08/01/2022 04:46:04 PM Eastern Daylight Time	08/03/2022 04:06:23 PM Eastern Daylight Time	07/30/2022 05:35:18 AM Eastern Daylight Time			08/04/2022 11:31:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	114	0	2023	Miami-Dade County		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:38:58 PM Eastern Daylight Time	08/03/2022 04:07:27 PM Eastern Daylight Time	07/30/2022 05:35:42 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	115	0	2023	Broward and Palm Beach Counties		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	116	0	1	01	01	H1019_116_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:39:07 PM Eastern Daylight Time	08/03/2022 04:08:32 PM Eastern Daylight Time	07/30/2022 05:36:06 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	116	0	2023	Orlando & Tampa Area		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:39:18 PM Eastern Daylight Time	08/03/2022 04:09:38 PM Eastern Daylight Time	07/30/2022 05:36:30 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze Platinum (HMO C-SNP)	01	01		1			H1019	117	0	2023	Brevard, Flagler, Indian River, & Volusia counties		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:39:29 PM Eastern Daylight Time	08/03/2022 04:10:42 PM Eastern Daylight Time	07/30/2022 05:36:56 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze Platinum (HMO C-SNP)	01	01		1			H1019	118	0	2023	Clay, Duval, and St. Johns counties		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	2	1			2	0	0	05/30/2022	2023.01	05/30/2022 09:18:13 AM Eastern Daylight Time	07/18/2022 05:17:51 PM Eastern Daylight Time				07/20/2022 01:47:38 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareSalute (HMO)	01	01		1			H1019	119	0	2023	Broward and Palm Beach Counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	08/01/2022	2023.01	08/01/2022 12:39:54 PM Eastern Daylight Time	08/03/2022 04:11:48 PM Eastern Daylight Time	07/30/2022 05:37:20 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	120	1	2023	Orlando Area	Lake, Marion, and Sumter counties	2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	120	2	1	01	01	H1019_120_2	3	1			2		1	08/01/2022	2023.01	08/01/2022 12:40:06 PM Eastern Daylight Time	08/03/2022 04:12:53 PM Eastern Daylight Time	07/30/2022 05:37:46 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	120	2	2023	Orlando Area	Orange, Osceola, and Seminole counties	2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	121	0	1	01	01	H1019_121_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 04:46:34 PM Eastern Daylight Time	08/03/2022 04:19:19 PM Eastern Daylight Time	07/30/2022 05:38:10 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete Platinum (HMO C-SNP)	01	01		1			H1019	121	0	2023	Miami-Dade County		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	122	0	1	01	01	H1019_122_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:40:58 PM Eastern Daylight Time	08/03/2022 04:30:12 PM Eastern Daylight Time	07/30/2022 05:38:34 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete Platinum (HMO C-SNP)	01	01		1			H1019	122	0	2023	Orlando & Tampa Area		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	123	0	1	01	01	H1019_123_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 04:46:49 PM Eastern Daylight Time	08/03/2022 04:20:22 PM Eastern Daylight Time	07/30/2022 05:39:00 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze Platinum (HMO C-SNP)	01	01		1			H1019	123	0	2023	Miami-Dade County		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	124	0	1	01	01	H1019_124_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:41:24 PM Eastern Daylight Time	08/03/2022 04:17:11 PM Eastern Daylight Time	07/30/2022 05:39:24 AM Eastern Daylight Time			08/04/2022 11:41:39 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze Platinum (HMO C-SNP)	01	01		1			H1019	124	0	2023	Broward and Palm Beach counties		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	125	0	1	01	01	H1019_125_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:41:37 PM Eastern Daylight Time	08/03/2022 04:31:19 PM Eastern Daylight Time	07/30/2022 05:39:48 AM Eastern Daylight Time			08/04/2022 11:49:06 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze Platinum (HMO C-SNP)	01	01		1			H1019	125	0	2023	Orlando & Tampa Area		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	126	0	1	01	01	H1019_126_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 04:47:05 PM Eastern Daylight Time	08/03/2022 04:25:48 PM Eastern Daylight Time	07/30/2022 05:40:12 AM Eastern Daylight Time			08/04/2022 11:49:06 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	126	0	2023	Brevard, Flagler, Indian River, & Volusia counties		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	127	0	1	01	01	H1019_127_0	4	1		1	2		1	08/01/2022	2023.01	08/01/2022 12:42:27 PM Eastern Daylight Time	08/03/2022 04:21:28 PM Eastern Daylight Time	07/30/2022 05:40:38 AM Eastern Daylight Time			08/04/2022 11:49:06 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	127	0	2023	Clay, Duval, and St. Johns counties		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	128	0	1	01	01	H1019_128_0	4	1		1	2		1	08/01/2022	2023.01	08/01/2022 12:42:39 PM Eastern Daylight Time	08/03/2022 04:26:54 PM Eastern Daylight Time	07/30/2022 05:41:02 AM Eastern Daylight Time			08/04/2022 11:49:06 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	128	0	2023	Clay, Duval, and St. Johns counties		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	129	0	1	01	01	H1019_129_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 04:47:19 PM Eastern Daylight Time	08/03/2022 04:24:44 PM Eastern Daylight Time	07/30/2022 05:41:26 AM Eastern Daylight Time			08/04/2022 11:49:06 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	129	0	2023	Brevard, Flagler, Indian River, & Volusia counties		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	130	0	1	01	01	H1019_130_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:43:32 PM Eastern Daylight Time	08/03/2022 04:16:07 PM Eastern Daylight Time	07/30/2022 05:41:52 AM Eastern Daylight Time			08/04/2022 11:49:06 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete Platinum (HMO C-SNP)	01	01		1			H1019	130	0	2023	Broward and Palm Beach counties		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	131	0	1	01	01	H1019_131_0	2	1			2	0	0	05/30/2022	2023.01	05/30/2022 09:21:39 AM Eastern Daylight Time	07/18/2022 05:22:51 PM Eastern Daylight Time				07/20/2022 01:55:30 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareSalute (HMO)	01	01		1			H1019	131	0	2023	Flagler and Volusia counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	132	0	1	01	01	H1019_132_0	2	1			2	0	0	05/30/2022	2023.01	05/30/2022 09:21:54 AM Eastern Daylight Time	07/18/2022 05:35:50 PM Eastern Daylight Time				07/20/2022 01:55:30 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareSalute (HMO)	01	01		1			H1019	132	0	2023	Tampa Area		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	133	0	1	01	01	H1019_133_0	2	1			2	0	0	05/29/2022	2023.01	05/29/2022 08:01:44 PM Eastern Daylight Time	07/18/2022 05:32:50 PM Eastern Daylight Time				07/20/2022 02:18:22 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareSalute (HMO)	01	01		1			H1019	133	0	2023	Orlando Area		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	134	0	1	01	01	H1019_134_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:16:27 PM Eastern Daylight Time	08/03/2022 04:15:02 PM Eastern Daylight Time	07/30/2022 05:42:18 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	134	0	2023	Brevard and Indian River counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	135	0	1	01	01	H1019_135_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 07:41:12 AM Eastern Daylight Time	08/03/2022 04:22:34 PM Eastern Daylight Time	07/30/2022 05:42:42 AM Eastern Daylight Time			08/04/2022 01:16:49 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree Platinum (HMO)	01	01		1			H1019	135	0	2023	Broward and Palm Beach counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	136	0	1	01	01	H1019_136_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:16:44 PM Eastern Daylight Time	08/03/2022 04:23:38 PM Eastern Daylight Time	07/30/2022 05:43:06 AM Eastern Daylight Time			08/04/2022 12:40:56 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree Platinum (HMO)	01	01		1			H1019	136	0	2023	Miami-Dade County		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	137	0	1	01	01	H1019_137_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:17:00 PM Eastern Daylight Time	08/03/2022 04:28:00 PM Eastern Daylight Time	07/30/2022 05:43:30 AM Eastern Daylight Time			08/04/2022 12:40:56 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree Platinum (HMO)	01	01		1			H1019	137	0	2023	Lake, Marion, and Sumter counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	138	0	1	01	01	H1019_138_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:17:14 PM Eastern Daylight Time	08/03/2022 04:29:05 PM Eastern Daylight Time	07/30/2022 05:43:56 AM Eastern Daylight Time			08/04/2022 12:40:56 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree Platinum (HMO)	01	01		1			H1019	138	0	2023	Orange, Osceola, and Seminole counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	139	0	1	01	01	H1019_139_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:17:27 PM Eastern Daylight Time	08/03/2022 04:13:58 PM Eastern Daylight Time	07/30/2022 05:44:20 AM Eastern Daylight Time			08/04/2022 12:40:56 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree Platinum (HMO)	01	01		1			H1019	139	0	2023	Brevard and Indian River counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	140	0	1	01	01	H1019_140_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:17:50 PM Eastern Daylight Time	08/03/2022 04:18:15 PM Eastern Daylight Time	07/30/2022 05:44:44 AM Eastern Daylight Time			08/04/2022 12:40:56 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree Platinum (HMO)	01	01		1			H1019	140	0	2023	Flagler and Volusia counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	141	0	1	02	01	H1019_141_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 03:18:14 PM Eastern Daylight Time	08/03/2022 04:32:22 PM Eastern Daylight Time	07/30/2022 05:45:10 AM Eastern Daylight Time			08/04/2022 12:40:56 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete Platinum (HMO-POS C-SNP)	01	02		1			H1019	141	0	2023	Hernando County		2		2			1	4			00000000000000000010000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	142	0	1	02	01	H1019_142_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 03:18:34 PM Eastern Daylight Time	08/03/2022 04:33:27 PM Eastern Daylight Time	07/30/2022 05:45:34 AM Eastern Daylight Time			08/04/2022 12:40:56 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze Platinum (HMO-POS C-SNP)	01	02		1			H1019	142	0	2023	Hernando County		2		2			1	4			00000000000100000000000					www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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	143	0	1	02	01	H1019_143_0	2	1			2	0	0	05/29/2022	2023.01	05/29/2022 08:04:33 PM Eastern Daylight Time	07/18/2022 05:38:53 PM Eastern Daylight Time				07/20/2022 02:27:54 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareSalute (HMO-POS)	01	02		1			H1019	143	0	2023	Brevard and Indian River counties		2		2			2									www.careplushealthplans.com/pharmacy-finder	https://www.careplushealthplans.com/medicare-plans/2022-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			
H1032	040	0	1	01	01	H1032_040_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 10:45:16 AM Eastern Daylight Time	08/03/2022 07:46:30 PM Eastern Daylight Time	07/30/2022 07:48:09 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	040	0	2023	Select counties in FL		2		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	6	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 10:50:03 AM Eastern Daylight Time	08/03/2022 07:47:42 PM Eastern Daylight Time	07/30/2022 07:48:41 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1032	124	0	2023	Select counties in FL		2		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	6	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 09:47:59 AM Eastern Daylight Time	08/03/2022 07:48:53 PM Eastern Daylight Time	07/30/2022 07:49:13 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1032	170	0	2023	Select counties in FL		2		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	6	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 09:11:39 AM Eastern Daylight Time	08/03/2022 07:50:05 PM Eastern Daylight Time	07/30/2022 07:49:45 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1032	175	0	2023	Select counties in FL		2		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	6	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 09:13:56 AM Eastern Daylight Time	08/03/2022 07:51:16 PM Eastern Daylight Time	07/30/2022 07:50:16 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1032	176	0	2023	Select counties in FL		2		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	6	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 10:58:41 AM Eastern Daylight Time	08/03/2022 07:52:28 PM Eastern Daylight Time	07/30/2022 07:50:49 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Select (HMO D-SNP)	01	01		1			H1032	182	0	2023	Select counties in FL		2		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	2		1	08/03/2022	2023.01	08/03/2022 03:45:10 PM Eastern Daylight Time	08/03/2022 07:53:40 PM Eastern Daylight Time	07/30/2022 07:51:20 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H1032	184	0	2023	Select counties in FL		2		2			1	4			00000000000000000010000					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	2		1	08/03/2022	2023.01	08/03/2022 03:47:30 PM Eastern Daylight Time	08/03/2022 07:54:53 PM Eastern Daylight Time	07/30/2022 07:51:52 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty Giveback (HMO C-SNP)	01	01		1			H1032	186	0	2023	Select counties in FL		2		2			1	4			00000000000000000010000					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			2		0	08/03/2022	2023.01	08/03/2022 03:48:47 PM Eastern Daylight Time	08/03/2022 07:56:07 PM Eastern Daylight Time	07/30/2022 07:52:24 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	189	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:04:22 AM Eastern Daylight Time	08/03/2022 07:57:19 PM Eastern Daylight Time	07/30/2022 07:52:55 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	190	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:05:33 AM Eastern Daylight Time	08/03/2022 07:58:31 PM Eastern Daylight Time	07/30/2022 07:53:26 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	191	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:06:42 AM Eastern Daylight Time	08/03/2022 07:59:43 PM Eastern Daylight Time	07/30/2022 07:53:57 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	192	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:07:44 AM Eastern Daylight Time	08/03/2022 08:00:57 PM Eastern Daylight Time	07/30/2022 07:54:29 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	193	0	2023	Select counties in FL		2		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	5	1			2		0	08/02/2022	2023.01	08/02/2022 11:08:53 AM Eastern Daylight Time	08/03/2022 08:02:09 PM Eastern Daylight Time	07/30/2022 07:55:01 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	194	0	2023	Select counties in FL		2		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	5	1			2		0	08/02/2022	2023.01	08/02/2022 11:09:58 AM Eastern Daylight Time	08/03/2022 08:03:23 PM Eastern Daylight Time	07/30/2022 07:55:32 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	195	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:11:00 AM Eastern Daylight Time	08/03/2022 08:04:37 PM Eastern Daylight Time	07/30/2022 07:56:04 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	196	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:12:04 AM Eastern Daylight Time	08/03/2022 08:05:47 PM Eastern Daylight Time	07/30/2022 07:56:35 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	198	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:13:09 AM Eastern Daylight Time	08/03/2022 08:06:58 PM Eastern Daylight Time	07/30/2022 07:57:06 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	199	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:14:13 AM Eastern Daylight Time	08/03/2022 08:08:10 PM Eastern Daylight Time	07/30/2022 07:57:37 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	200	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:15:12 AM Eastern Daylight Time	08/03/2022 08:09:22 PM Eastern Daylight Time	07/30/2022 07:58:11 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	201	0	2023	Select counties in FL		2		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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 02:55:52 PM Eastern Daylight Time	08/03/2022 08:10:32 PM Eastern Daylight Time	07/30/2022 07:58:46 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	202	0	2023	Select counties in FL		2		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	2		1	08/02/2022	2023.01	08/02/2022 11:16:33 AM Eastern Daylight Time	08/03/2022 08:11:46 PM Eastern Daylight Time	07/30/2022 07:59:18 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty Giveback (HMO C-SNP)	01	01		1			H1032	203	0	2023	Select counties in FL		2		2			1	4			00000000000000000010000					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			2		0	08/02/2022	2023.01	08/02/2022 11:17:47 AM Eastern Daylight Time	08/03/2022 08:12:58 PM Eastern Daylight Time	07/30/2022 07:59:49 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	204	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:18:52 AM Eastern Daylight Time	08/03/2022 08:14:10 PM Eastern Daylight Time	07/30/2022 08:00:21 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	205	0	2023	Select counties in FL		2		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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 03:08:46 PM Eastern Daylight Time	08/03/2022 08:15:22 PM Eastern Daylight Time	07/30/2022 08:00:53 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	206	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:20:03 AM Eastern Daylight Time	08/03/2022 08:16:35 PM Eastern Daylight Time	07/30/2022 08:01:24 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	209	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:21:12 AM Eastern Daylight Time	08/03/2022 08:17:50 PM Eastern Daylight Time	07/30/2022 08:01:55 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	210	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:22:32 AM Eastern Daylight Time	08/03/2022 08:19:02 PM Eastern Daylight Time	07/30/2022 08:02:27 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	211	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:23:44 AM Eastern Daylight Time	08/03/2022 08:20:14 PM Eastern Daylight Time	07/30/2022 08:02:58 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	212	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:24:47 AM Eastern Daylight Time	08/03/2022 08:21:25 PM Eastern Daylight Time	07/30/2022 08:03:29 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	213	0	2023	Select counties in FL		2		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	6	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 11:25:52 AM Eastern Daylight Time	08/03/2022 08:22:37 PM Eastern Daylight Time	07/30/2022 08:04:02 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	214	0	2023	Select counties in FL		2		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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 03:15:03 PM Eastern Daylight Time	08/03/2022 08:23:49 PM Eastern Daylight Time	07/30/2022 08:04:34 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	217	0	2023	Select counties in FL		2		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			2		0	08/02/2022	2023.01	08/02/2022 11:26:56 AM Eastern Daylight Time	08/03/2022 08:25:03 PM Eastern Daylight Time	07/30/2022 08:05:05 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	218	0	2023	Select counties in FL		2		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	2		1	08/02/2022	2023.01	08/02/2022 11:28:02 AM Eastern Daylight Time	08/03/2022 08:26:15 PM Eastern Daylight Time	07/30/2022 08:05:37 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H1032	224	0	2023	Select counties in FL		2		2			1	4			00000000000000000010000					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	2		1	08/02/2022	2023.01	08/02/2022 11:29:08 AM Eastern Daylight Time	08/03/2022 08:27:28 PM Eastern Daylight Time	07/30/2022 08:06:08 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty Giveback (HMO C-SNP)	01	01		1			H1032	227	0	2023	Select counties in FL		2		2			1	4			00000000000000000010000					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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 03:18:26 PM Eastern Daylight Time	08/03/2022 09:13:47 PM Eastern Daylight Time	07/30/2022 08:06:41 AM Eastern Daylight Time			08/04/2022 05:35:09 PM Eastern Daylight Time	Sunshine State Health Plan, Inc.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	236	0	2023	Select counties in FL		2		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	10	1						07/19/2022	2023.01	07/19/2022 03:31:30 PM Eastern Daylight Time	08/05/2022 02:33:05 PM Eastern Daylight Time	08/05/2022 04:26:20 PM Eastern Daylight Time			08/05/2022 05:27:13 PM 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	2023	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	9	1						08/05/2022	2023.01	08/05/2022 12:16:39 PM Eastern Daylight Time	08/05/2022 03:23:37 PM Eastern Daylight Time	08/05/2022 04:28:21 PM Eastern Daylight Time			08/05/2022 05:27:13 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Rx (HMO)	01	01		1			H1035	006	0	2023	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	9	1						08/05/2022	2023.01	08/05/2022 03:41:11 PM Eastern Daylight Time	08/05/2022 03:32:07 PM Eastern Daylight Time	08/05/2022 04:30:23 PM Eastern Daylight Time			08/05/2022 05:27:13 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Premier Plus (HMO)	01	01		1			H1035	011	0	2023	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	9	1						08/05/2022	2023.01	08/05/2022 01:42:40 PM Eastern Daylight Time	08/05/2022 03:35:31 PM Eastern Daylight Time	08/05/2022 04:33:35 PM Eastern Daylight Time			08/05/2022 05:27:13 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Rx Savings (HMO)	01	01		1			H1035	014	0	2023	Brevard, Flagler, Seminole 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	016	0	1	01	01	H1035_016_0	9	1						08/05/2022	2023.01	08/05/2022 01:43:10 PM Eastern Daylight Time	08/05/2022 04:01:15 PM Eastern Daylight Time	08/05/2022 04:36:20 PM Eastern Daylight Time			08/05/2022 05:27:13 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Flagler Advantage (HMO)	01	01		1			H1035	016	0	2023	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	6	1			2		1	08/04/2022	2023.01	08/04/2022 03:08:48 PM Eastern Daylight Time	08/04/2022 02:32:53 PM Eastern Daylight Time	08/03/2022 04:37:31 PM Eastern Daylight Time			08/05/2022 09:22:26 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	017	0	2023	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	6	1			2		1	08/03/2022	2023.01	08/03/2022 03:32:42 PM Eastern Daylight Time	08/04/2022 11:45:10 AM Eastern Daylight Time	08/03/2022 04:43:38 PM Eastern Daylight Time			08/05/2022 09:22:26 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	018	0	2023	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			2		1	08/04/2022	2023.01	08/04/2022 03:09:45 PM Eastern Daylight Time	08/04/2022 11:45:43 AM Eastern Daylight Time	08/03/2022 04:49:47 PM Eastern Daylight Time			08/05/2022 09:22:26 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	019	0	2023	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	6	1			2		1	08/03/2022	2023.01	08/03/2022 03:35:36 PM Eastern Daylight Time	08/04/2022 11:46:15 AM Eastern Daylight Time	08/03/2022 04:56:37 PM Eastern Daylight Time			08/05/2022 09:22:26 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	020	0	2023	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	6	1			2		1	08/03/2022	2023.01	08/03/2022 03:36:15 PM Eastern Daylight Time	08/04/2022 11:46:47 AM Eastern Daylight Time	08/03/2022 05:02:47 PM Eastern Daylight Time			08/05/2022 09:22:26 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	021	0	2023	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	8	1			2		1	08/03/2022	2023.01	08/03/2022 03:36:51 PM Eastern Daylight Time	08/04/2022 11:47:21 AM Eastern Daylight Time	08/03/2022 05:08:56 PM Eastern Daylight Time			08/05/2022 04:41:31 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	022	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:38:07 PM Eastern Daylight Time	08/04/2022 11:47:53 AM Eastern Daylight Time	08/03/2022 05:15:07 PM Eastern Daylight Time			08/05/2022 04:41:31 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	023	0	2023	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	10	1			2		1	08/03/2022	2023.01	08/03/2022 03:39:22 PM Eastern Daylight Time	08/04/2022 11:48:29 AM Eastern Daylight Time	08/03/2022 05:21:14 PM Eastern Daylight Time			08/05/2022 04:41:31 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	024	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:40:00 PM Eastern Daylight Time	08/04/2022 11:49:02 AM Eastern Daylight Time	08/03/2022 05:27:22 PM Eastern Daylight Time			08/05/2022 04:53:06 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	025	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:40:56 PM Eastern Daylight Time	08/04/2022 11:49:35 AM Eastern Daylight Time	08/03/2022 05:33:30 PM Eastern Daylight Time			08/05/2022 04:53:06 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	026	0	2023	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	1		0	08/03/2022	2023.01	08/03/2022 03:57:10 PM Eastern Daylight Time	08/04/2022 11:50:08 AM Eastern Daylight Time	08/03/2022 05:39:35 PM Eastern Daylight Time			08/05/2022 04:53:06 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	2023	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	6	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 03:56:43 PM Eastern Daylight Time	08/04/2022 11:50:41 AM Eastern Daylight Time	08/03/2022 05:45:44 PM Eastern Daylight Time			08/05/2022 05:05:22 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	2023	Broward, Palm Beach and St. Lucie counties		2		2			1	3		1					1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	029	0	1	01	01	H1035_029_0	6	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 03:56:09 PM Eastern Daylight Time	08/04/2022 11:51:14 AM Eastern Daylight Time	08/03/2022 05:51:54 PM Eastern Daylight Time			08/05/2022 05:05:22 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	2023	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	1		0	08/03/2022	2023.01	08/03/2022 03:58:38 PM Eastern Daylight Time	08/04/2022 11:51:47 AM Eastern Daylight Time	08/03/2022 05:58:02 PM Eastern Daylight Time			08/05/2022 05:05:22 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	2023	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	1		0	08/03/2022	2023.01	08/03/2022 03:59:34 PM Eastern Daylight Time	08/04/2022 11:52:31 AM Eastern Daylight Time	08/03/2022 06:04:13 PM Eastern Daylight Time			08/05/2022 05:05:22 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	2023	Clay, Duval and 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	1		0	08/03/2022	2023.01	08/03/2022 04:00:29 PM Eastern Daylight Time	08/04/2022 11:53:13 AM Eastern Daylight Time	08/03/2022 09:47:58 PM Eastern Daylight Time			08/05/2022 05:21:11 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	2023	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	6	1			2		1	08/03/2022	2023.01	08/03/2022 03:41:33 PM Eastern Daylight Time	08/04/2022 11:54:01 AM Eastern Daylight Time	08/03/2022 09:48:31 PM Eastern Daylight Time			08/05/2022 05:21:11 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	033	0	2023	Clay and 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	6	1			2		1	08/04/2022	2023.01	08/04/2022 10:42:16 AM Eastern Daylight Time	08/04/2022 11:54:34 AM Eastern Daylight Time	08/03/2022 09:49:04 PM Eastern Daylight Time			08/05/2022 05:21:11 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	034	0	2023	Hernando, Pasco and 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	7	1			2		1	08/03/2022	2023.01	08/03/2022 04:02:16 PM Eastern Daylight Time	08/04/2022 11:55:06 AM Eastern Daylight Time	08/04/2022 04:26:25 PM Eastern Daylight Time			08/05/2022 05:21:11 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	01	01		1			H1035	035	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 04:02:49 PM Eastern Daylight Time	08/04/2022 11:56:10 AM Eastern Daylight Time	08/03/2022 09:50:10 PM Eastern Daylight Time			08/05/2022 05:21:11 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	01	01		1			H1035	037	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 04:03:18 PM Eastern Daylight Time	08/04/2022 11:56:51 AM Eastern Daylight Time	08/03/2022 09:50:43 PM Eastern Daylight Time			08/05/2022 05:21:11 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	01	01		1			H1035	038	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 04:03:48 PM Eastern Daylight Time	08/04/2022 11:57:32 AM Eastern Daylight Time	08/03/2022 09:51:16 PM Eastern Daylight Time			08/05/2022 05:35:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	01	01		1			H1035	039	0	2023	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	10	1						08/05/2022	2023.01	08/05/2022 01:43:35 PM Eastern Daylight Time	08/05/2022 04:13:03 PM Eastern Daylight Time	08/05/2022 04:39:01 PM Eastern Daylight Time			08/05/2022 05:27:13 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Premier Advantage (HMO)	01	01		1			H1035	040	0	2023	Brevard, Flagler, Seminole 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	043	0	1	01	01	H1035_043_0	8	1			2		1	08/03/2022	2023.01	08/03/2022 03:42:30 PM Eastern Daylight Time	08/04/2022 11:58:02 AM Eastern Daylight Time	08/03/2022 09:51:48 PM Eastern Daylight Time			08/05/2022 05:35:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	043	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:43:00 PM Eastern Daylight Time	08/04/2022 11:58:42 AM Eastern Daylight Time	08/03/2022 09:52:22 PM Eastern Daylight Time			08/05/2022 05:35:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	045	0	2023	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	7	1			2		1	09/13/2022	2023.01	09/13/2022 05:23:11 PM Eastern Daylight Time	08/04/2022 11:59:23 AM Eastern Daylight Time	08/03/2022 09:52:56 PM Eastern Daylight Time			09/13/2022 05:38:42 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic Plus (HMO)	01	01		1			H1035	046	0	2023	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	6	1			2		1	08/03/2022	2023.01	08/03/2022 03:34:56 PM Eastern Daylight Time	08/04/2022 12:24:11 PM Eastern Daylight Time	08/03/2022 09:53:30 PM Eastern Daylight Time			08/05/2022 09:22:26 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic Plus (HMO)	01	01		1			H1035	047	0	2023	Counties: Bay, Escambia, Okaloosa, SRosa, Walton		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			2		1	08/03/2022	2023.01	08/03/2022 03:43:27 PM Eastern Daylight Time	08/04/2022 12:27:56 PM Eastern Daylight Time	08/03/2022 09:54:03 PM Eastern Daylight Time			08/05/2022 05:35:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	048	0	2023	Brevard and 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	050	0	1	01	01	H1035_050_0	9	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 04:01:33 PM Eastern Daylight Time	08/19/2022 09:36:43 AM Eastern Daylight Time	08/05/2022 07:59:55 PM Eastern Daylight Time			08/19/2022 11:59:51 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	01	01		1			H1035	050	0	2023	Escambia, Okaloosa, Santa Rosa, & Walton counties		2		2			1	3		1					1	MyPrime.com	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	801	0	1	01	01	H1035_801_0	4	1						06/06/2022	2023.01	06/06/2022 02:02:07 PM Eastern Daylight Time					06/06/2022 09:20:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Group HMO (HMO)	01	01		1			H1035	801	0	2023	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	4	1						06/06/2022	2023.01	06/06/2022 02:03:53 PM Eastern Daylight Time					06/06/2022 09:20:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Group HMO (HMO)	01	01		1			H1035	802	0	2023	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	5	1			1		1	08/01/2022	2023.01	08/01/2022 10:48:23 AM Eastern Daylight Time	08/03/2022 05:48:17 PM Eastern Daylight Time	07/30/2022 05:45:58 AM Eastern Daylight Time			08/04/2022 01:39:41 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	2023	Counties: HER, HIL, PAS, PIN		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	044	0	1	01	01	H1036_044_0	5	1			1		1	08/01/2022	2023.01	08/01/2022 10:49:34 AM Eastern Daylight Time	08/03/2022 06:04:45 PM Eastern Daylight Time	07/30/2022 05:46:22 AM Eastern Daylight Time			08/04/2022 01:39:41 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	2023	Flagler and Volusia counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/03/2022	2023.01	08/03/2022 04:56:42 PM Eastern Daylight Time	08/03/2022 05:23:45 PM Eastern Daylight Time	07/30/2022 05:46:48 AM Eastern Daylight Time			08/04/2022 01:59:01 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	2023	Miami-Dade County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			2	0	0	05/29/2022	2023.01	05/29/2022 11:42:46 AM Eastern Daylight Time	07/18/2022 05:02:47 PM Eastern Daylight Time				07/20/2022 01:15:28 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	056	0	2023	Flagler and Volusia counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1		1	08/03/2022	2023.01	08/03/2022 04:23:51 PM Eastern Daylight Time	08/03/2022 05:31:56 PM Eastern Daylight Time	07/30/2022 05:47:12 AM Eastern Daylight Time			08/04/2022 01:59:01 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	2023	Palm Beach County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	065	0	1	01	01	H1036_065_0	5	1			1		1	08/03/2022	2023.01	08/03/2022 04:22:21 PM Eastern Daylight Time	08/03/2022 05:31:30 PM Eastern Daylight Time	07/30/2022 05:47:38 AM Eastern Daylight Time			08/04/2022 01:59:01 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	2023	Broward County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	068	0	1	01	01	H1036_068_0	5	1			1		1	08/01/2022	2023.01	08/01/2022 11:06:53 AM Eastern Daylight Time	08/03/2022 05:32:46 PM Eastern Daylight Time	07/30/2022 05:48:02 AM Eastern Daylight Time			08/04/2022 01:39:41 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	2023	Jacksonville Metro area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/01/2022	2023.01	08/01/2022 11:07:09 AM Eastern Daylight Time	08/03/2022 05:32:09 PM Eastern Daylight Time	07/30/2022 05:48:26 AM Eastern Daylight Time			08/04/2022 01:39:41 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	2023	Manatee and Sarasota counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	077	0	1	01	01	H1036_077_0	4	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 10:38:04 AM Eastern Daylight Time	08/03/2022 05:24:41 PM Eastern Daylight Time	07/30/2022 05:48:52 AM Eastern Daylight Time			08/04/2022 01:59:01 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	2023	Broward, Miami-Dade, and Palm Beach counties		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 12:03:02 PM Eastern Daylight Time	08/03/2022 05:38:24 PM Eastern Daylight Time	07/30/2022 05:49:16 AM Eastern Daylight Time			08/04/2022 01:39:41 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	2023	Counties: CIT, HER, HIL, MAN, PAS, PIN		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			2	0	0	05/29/2022	2023.01	05/29/2022 11:44:08 AM Eastern Daylight Time	07/18/2022 05:02:10 PM Eastern Daylight Time				07/20/2022 01:15:28 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	119	0	2023	Counties: CIT, HER, HIL, MAN, PAS, PIN, SAR		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	121	0	1	01	01	H1036_121_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:17:05 PM Eastern Daylight Time	08/03/2022 05:23:18 PM Eastern Daylight Time	07/30/2022 05:49:42 AM Eastern Daylight Time			08/04/2022 01:59:01 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	2023	Broward, Miami-Dade, and Palm Beach counties		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H1036_137_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:38:13 PM Eastern Daylight Time	08/03/2022 04:04:55 PM Eastern Daylight Time	07/30/2022 05:50:06 AM Eastern Daylight Time			08/04/2022 03:19:24 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-137 (HMO-POS)	01	02		1			H1036	137	0	2023	Charlotte Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/01/2022	2023.01	08/01/2022 11:07:20 AM Eastern Daylight Time	08/03/2022 05:33:24 PM Eastern Daylight Time	07/30/2022 05:50:30 AM Eastern Daylight Time			08/04/2022 01:39:41 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	2023	Citrus county		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	143	0	1	01	01	H1036_143_0	5	1			1		1	08/01/2022	2023.01	08/01/2022 11:07:30 AM Eastern Daylight Time	08/03/2022 05:34:01 PM Eastern Daylight Time	07/30/2022 05:50:56 AM Eastern Daylight Time			08/04/2022 01:39:41 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	2023	Counties: BAY, ESC, OKA, SAN, WAL		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 11:07:40 AM Eastern Daylight Time	08/03/2022 05:34:39 PM Eastern Daylight Time	07/30/2022 05:51:20 AM Eastern Daylight Time			08/04/2022 01:39:41 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	2023	Counties: LAK, MRN, ORA, OSC, SEM, SUM		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:09:19 PM Eastern Daylight Time	08/03/2022 03:47:37 PM Eastern Daylight Time	07/30/2022 05:51:44 AM Eastern Daylight Time			08/04/2022 02:34:26 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	2023	Jackson Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 11:12:45 AM Eastern Daylight Time	08/03/2022 03:44:07 PM Eastern Daylight Time	07/30/2022 05:52:08 AM Eastern Daylight Time			08/04/2022 11:06:38 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-153 (HMO)	01	01		1			H1036	153	0	2023	Select Counties in OR		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1		1	1		1	08/01/2022	2023.01	08/01/2022 11:07:50 AM Eastern Daylight Time	08/03/2022 05:35:17 PM Eastern Daylight Time	07/30/2022 05:52:34 AM Eastern Daylight Time			08/04/2022 01:48:40 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	156	0	2023	Flagler and Volusia counties		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:08:04 AM Eastern Daylight Time	08/03/2022 05:36:32 PM Eastern Daylight Time	07/30/2022 05:52:58 AM Eastern Daylight Time			08/04/2022 01:48:40 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	2023	Flagler and Volusia counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 11:08:15 AM Eastern Daylight Time	08/03/2022 05:35:54 PM Eastern Daylight Time	07/30/2022 05:53:22 AM Eastern Daylight Time			08/04/2022 01:48:40 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	160	0	2023	Counties: CIT, HER, HIL, MAN, PAS, PIN, SAR		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H1036_167_0	3	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 02:48:15 PM Eastern Daylight Time	08/03/2022 04:01:00 PM Eastern Daylight Time	07/30/2022 05:53:48 AM Eastern Daylight Time			08/04/2022 03:19:24 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-167 (HMO-POS D-SNP)	01	02		1			H1036	167	0	2023	Charlotte Metro Area		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H1036_168_0	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:38:39 PM Eastern Daylight Time	08/03/2022 04:01:30 PM Eastern Daylight Time	07/30/2022 05:54:12 AM Eastern Daylight Time			08/04/2022 03:19:24 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-168 (HMO-POS D-SNP)	01	02		1			H1036	168	0	2023	Greensboro / Winston-Salem Metro Area		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 04:09:33 PM Eastern Daylight Time	08/03/2022 03:50:56 PM Eastern Daylight Time	07/30/2022 05:54:36 AM Eastern Daylight Time			08/04/2022 02:34:26 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	2023	Gulf Coast Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 11:08:24 AM Eastern Daylight Time	08/03/2022 05:37:10 PM Eastern Daylight Time	07/30/2022 05:55:00 AM Eastern Daylight Time			08/04/2022 01:48:40 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	2023	Jacksonville Metro area		2		2			1	4			00000010000000000000000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 01:55:27 PM Eastern Daylight Time	08/03/2022 05:40:13 PM Eastern Daylight Time	07/30/2022 05:55:26 AM Eastern Daylight Time			08/04/2022 01:48:40 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	2023	Flagler and Volusia counties		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 01:56:16 PM Eastern Daylight Time	08/03/2022 05:40:50 PM Eastern Daylight Time	07/30/2022 05:55:50 AM Eastern Daylight Time			08/04/2022 01:48:40 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	2023	Jacksonville Metro area		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 01:57:01 PM Eastern Daylight Time	08/03/2022 05:39:37 PM Eastern Daylight Time	07/30/2022 05:56:14 AM Eastern Daylight Time			08/04/2022 01:48:40 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	2023	Counties: LAK, MRN, ORA, OSC, SEM, SUM		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 02:01:12 PM Eastern Daylight Time	08/03/2022 05:41:26 PM Eastern Daylight Time	07/30/2022 05:56:38 AM Eastern Daylight Time			08/04/2022 01:53:39 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	2023	Counties: BAY, ESC, OKA, SAN, WAL		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:26:06 AM Eastern Daylight Time	08/03/2022 05:49:32 PM Eastern Daylight Time	07/30/2022 05:57:02 AM Eastern Daylight Time			08/04/2022 01:53:39 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	2023	Charlotte, Collier, DeSoto and Lee counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/29/2022	2023.01	05/29/2022 09:19:02 PM Eastern Daylight Time	08/03/2022 03:45:29 PM Eastern Daylight Time	07/30/2022 05:57:28 AM Eastern Daylight Time			08/04/2022 11:06:38 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-219 (HMO)	01	01		1			H1036	219	0	2023	Select Counties in OR		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 06:52:49 PM Eastern Daylight Time	08/03/2022 03:53:14 PM Eastern Daylight Time	07/30/2022 05:57:52 AM Eastern Daylight Time			08/04/2022 02:34:26 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	2023	Select Counties in Mississippi		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 04:09:48 PM Eastern Daylight Time	08/03/2022 03:51:24 PM Eastern Daylight Time	07/30/2022 05:58:16 AM Eastern Daylight Time			08/04/2022 02:34:26 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	2023	DeSoto County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 10:38:33 AM Eastern Daylight Time	08/03/2022 05:25:09 PM Eastern Daylight Time	07/30/2022 05:58:42 AM Eastern Daylight Time			08/04/2022 01:59:01 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	2023	Treasure Coast		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:18:28 PM Eastern Daylight Time	08/03/2022 05:24:13 PM Eastern Daylight Time	07/30/2022 05:59:06 AM Eastern Daylight Time			08/04/2022 01:59:01 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	2023	Treasure Coast		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:37:29 AM Eastern Daylight Time	08/03/2022 05:37:47 PM Eastern Daylight Time	07/30/2022 05:59:30 AM Eastern Daylight Time			08/04/2022 02:06:10 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	2023	Hardee, Highlands and Polk counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	231	0	1	01	01	H1036_231_0	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 01:49:36 PM Eastern Daylight Time	08/03/2022 05:39:00 PM Eastern Daylight Time	07/30/2022 05:59:56 AM Eastern Daylight Time			08/04/2022 02:06:10 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	2023	Hardee, Highlands and Polk counties		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H1036_233_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:39:09 PM Eastern Daylight Time	08/03/2022 04:05:23 PM Eastern Daylight Time	07/30/2022 06:00:18 AM Eastern Daylight Time			08/04/2022 03:19:24 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-233 (HMO-POS)	01	02		1			H1036	233	0	2023	Raleigh Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 01:18:22 PM Eastern Daylight Time	08/03/2022 04:38:04 PM Eastern Daylight Time	07/30/2022 06:00:44 AM Eastern Daylight Time			08/04/2022 05:11:45 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	2023	Jefferson County		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:25:19 PM Eastern Daylight Time	08/03/2022 04:38:47 PM Eastern Daylight Time	07/30/2022 06:01:08 AM Eastern Daylight Time			08/04/2022 05:11:45 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	2023	Jefferson County		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	236	0	1	01	01	H1036_236_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:20:18 PM Eastern Daylight Time	08/03/2022 04:37:19 PM Eastern Daylight Time	07/30/2022 06:01:32 AM Eastern Daylight Time			08/04/2022 05:11:45 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H1036	236	0	2023	Jefferson County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 12:04:28 PM Eastern Daylight Time	08/03/2022 05:42:03 PM Eastern Daylight Time	07/30/2022 06:01:56 AM Eastern Daylight Time			08/04/2022 02:06:10 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	2023	Sarasota county		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:37:40 AM Eastern Daylight Time	08/03/2022 05:47:03 PM Eastern Daylight Time	07/30/2022 06:02:22 AM Eastern Daylight Time			08/04/2022 02:06:10 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	2023	Tampa Metro area	Counties: HER, HIL, PAS, PIN	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:37:49 AM Eastern Daylight Time	08/03/2022 05:45:10 PM Eastern Daylight Time	07/30/2022 06:02:46 AM Eastern Daylight Time			08/04/2022 02:06:10 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	2023	Tampa Metro area	Manatee and Sarasota Counties	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:37:59 AM Eastern Daylight Time	08/03/2022 05:44:31 PM Eastern Daylight Time	07/30/2022 06:03:10 AM Eastern Daylight Time			08/04/2022 02:06:10 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	2023	Citrus County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:38:09 AM Eastern Daylight Time	08/03/2022 05:45:48 PM Eastern Daylight Time	07/30/2022 06:03:36 AM Eastern Daylight Time			08/04/2022 02:06:10 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	2023	Hardee, Highlands and Polk counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:38:18 AM Eastern Daylight Time	08/03/2022 05:46:26 PM Eastern Daylight Time	07/30/2022 06:04:00 AM Eastern Daylight Time			08/04/2022 02:06:10 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	2023	Counties: LAK, MRN, ORA, OSC, SEM, SUM		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:08:35 AM Eastern Daylight Time	08/03/2022 05:48:54 PM Eastern Daylight Time	07/30/2022 06:04:24 AM Eastern Daylight Time			08/04/2022 01:48:40 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	2023	Jacksonville Metro area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:26:18 AM Eastern Daylight Time	08/03/2022 05:47:40 PM Eastern Daylight Time	07/30/2022 06:04:48 AM Eastern Daylight Time			08/04/2022 01:53:39 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	2023	Counties: BAY, ESC, OKA, SAN, WAL		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H1036_276_0	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:39:41 PM Eastern Daylight Time	08/03/2022 04:09:11 PM Eastern Daylight Time	07/30/2022 06:05:14 AM Eastern Daylight Time			08/04/2022 03:19:24 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-276 (HMO-POS D-SNP)	01	02		1			H1036	276	0	2023	Raleigh Metro Area		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:26:31 AM Eastern Daylight Time	08/03/2022 05:52:24 PM Eastern Daylight Time	07/30/2022 06:05:38 AM Eastern Daylight Time			08/04/2022 01:53:39 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	2023	Charlotte, Collier, DeSoto and Lee counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			2	0	0	05/28/2022	2023.01	05/28/2022 09:26:05 AM Eastern Daylight Time	07/18/2022 05:12:25 PM Eastern Daylight Time				07/20/2022 02:27:20 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	279	0	2023	Broward, Miami-Dade, and Palm Beach counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 10:38:52 AM Eastern Daylight Time	08/03/2022 05:26:29 PM Eastern Daylight Time	07/30/2022 06:06:02 AM Eastern Daylight Time			08/04/2022 01:59:01 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	2023	Select Counties in Central and South Florida		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 02:02:00 PM Eastern Daylight Time	08/03/2022 05:55:17 PM Eastern Daylight Time	07/30/2022 06:06:26 AM Eastern Daylight Time			08/04/2022 01:53:39 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	2023	Charlotte, Collier, DeSoto and Lee counties		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 02:02:39 PM Eastern Daylight Time	08/03/2022 05:56:43 PM Eastern Daylight Time	07/30/2022 06:06:52 AM Eastern Daylight Time			08/04/2022 01:53:39 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	2023	Charlotte, Collier, DeSoto and Lee counties		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:23:14 PM Eastern Daylight Time	08/03/2022 05:26:56 PM Eastern Daylight Time	07/30/2022 06:07:16 AM Eastern Daylight Time			08/04/2022 01:45:35 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	2023	Indian River, Martin, St. Lucie counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 11:56:13 AM Eastern Daylight Time	07/18/2022 05:22:08 PM Eastern Daylight Time				07/20/2022 01:39:15 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	287	0	2023	Counties: BAY, ESC, OKA, SAN, WAL		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1			2	0	0	05/29/2022	2023.01	05/29/2022 11:56:38 AM Eastern Daylight Time	07/18/2022 05:23:24 PM Eastern Daylight Time				07/20/2022 01:39:15 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	288	0	2023	Charlotte, Collier, DeSoto and Lee counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1			2	0	0	05/29/2022	2023.01	05/29/2022 11:35:06 AM Eastern Daylight Time	07/18/2022 05:24:01 PM Eastern Daylight Time				07/20/2022 02:27:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	289	0	2023	Hardee, Highlands and Polk counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/29/2022	2023.01	05/29/2022 11:35:28 AM Eastern Daylight Time	07/18/2022 05:21:31 PM Eastern Daylight Time				07/20/2022 02:27:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	290	0	2023	Counties: LAK, MRN, ORA, OSC, SEM, SUM		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	291	0	1	02	01	H1036_291_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:40:03 PM Eastern Daylight Time	08/03/2022 04:15:27 PM Eastern Daylight Time	07/30/2022 06:07:40 AM Eastern Daylight Time			08/04/2022 03:19:24 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-291 (HMO-POS)	01	02		1			H1036	291	0	2023	Greensboro - Winston Salem Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 12:23:27 PM Eastern Daylight Time	08/03/2022 05:27:25 PM Eastern Daylight Time	07/30/2022 06:08:04 AM Eastern Daylight Time			08/04/2022 01:45:35 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	2023	Indian River, Martin, St. Lucie counties		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			2	0	0	05/29/2022	2023.01	05/29/2022 11:57:03 AM Eastern Daylight Time	07/18/2022 05:24:40 PM Eastern Daylight Time				07/20/2022 01:42:57 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	293	0	2023	Jacksonville Metro area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	295	0	1	01	01	H1036_295_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:38:27 AM Eastern Daylight Time	08/03/2022 05:58:49 PM Eastern Daylight Time	07/30/2022 06:08:28 AM Eastern Daylight Time			08/04/2022 02:10:43 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H1036	295	0	2023	Lake, Marion and Sumter counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 11:38:37 AM Eastern Daylight Time	08/03/2022 05:59:27 PM Eastern Daylight Time	07/30/2022 06:08:52 AM Eastern Daylight Time			08/04/2022 02:10:43 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	2023	Hardee, Highlands and Polk counties		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	297	0	1	01	01	H1036_297_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:19:48 PM Eastern Daylight Time	08/03/2022 05:29:15 PM Eastern Daylight Time	07/30/2022 06:09:18 AM Eastern Daylight Time			08/04/2022 01:59:01 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus Lung (HMO C-SNP)	01	01		1			H1036	297	0	2023	Broward, Miami-Dade, and Palm Beach counties		2		2			1	4			00000000000100000000000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	298	0	1	01	01	H1036_298_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:21:05 PM Eastern Daylight Time	08/03/2022 05:29:41 PM Eastern Daylight Time	07/30/2022 06:09:42 AM Eastern Daylight Time			08/04/2022 01:59:01 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus Lung (HMO C-SNP)	01	01		1			H1036	298	0	2023	Indian River, Martin, St. Lucie counties		2		2			1	4			00000000000100000000000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	299	0	1	01	01	H1036_299_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 11:38:47 AM Eastern Daylight Time	08/03/2022 06:02:42 PM Eastern Daylight Time	07/30/2022 06:10:06 AM Eastern Daylight Time			08/04/2022 02:10:43 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	299	0	2023	Counties: HER, HIL, PAS, PIN		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	300	0	1	01	01	H1036_300_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 11:38:57 AM Eastern Daylight Time	08/03/2022 06:04:04 PM Eastern Daylight Time	07/30/2022 06:10:30 AM Eastern Daylight Time			08/04/2022 02:10:43 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	300	0	2023	Counties: LAK, MRN, ORA, OSC, SEM, SUM		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	301	0	1	01	01	H1036_301_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 11:08:46 AM Eastern Daylight Time	08/03/2022 06:02:03 PM Eastern Daylight Time	07/30/2022 06:10:54 AM Eastern Daylight Time			08/04/2022 01:48:40 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	301	0	2023	Flagler and Volusia counties		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	302	0	1	01	01	H1036_302_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 11:08:56 AM Eastern Daylight Time	08/03/2022 06:01:22 PM Eastern Daylight Time	07/30/2022 06:11:18 AM Eastern Daylight Time			08/04/2022 01:48:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO C-SNP)	01	01		1			H1036	302	0	2023	Jacksonville Metro area		2		2			1	4			00000010000000000000000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	303	0	1	01	01	H1036_303_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 03:00:40 PM Eastern Daylight Time	08/03/2022 06:03:23 PM Eastern Daylight Time	07/30/2022 06:11:42 AM Eastern Daylight Time			08/04/2022 01:48:40 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	303	0	2023	Counties: BAY, ESC, OKA, SAN, WAL		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	304	0	1	01	01	H1036_304_0	4	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 12:24:09 PM Eastern Daylight Time	08/03/2022 05:30:35 PM Eastern Daylight Time	07/30/2022 06:12:08 AM Eastern Daylight Time			08/04/2022 01:45:35 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP)	01	01		1			H1036	304	0	2023	Broward, Miami-Dade, and Palm Beach counties		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	305	0	1	01	01	H1036_305_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:23:52 PM Eastern Daylight Time	08/03/2022 05:31:02 PM Eastern Daylight Time	07/30/2022 06:12:32 AM Eastern Daylight Time			08/04/2022 01:45:35 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-305 (HMO)	01	01		1			H1036	305	0	2023	Broward, Miami-Dade, and Palm Beach counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	306	0	1	01	01	H1036_306_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 02:58:46 PM Eastern Daylight Time	08/03/2022 04:04:30 PM Eastern Daylight Time	07/30/2022 06:12:56 AM Eastern Daylight Time			08/04/2022 12:09:47 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO C-SNP)	01	01		1			H1036	306	0	2023	Select Counties in OR		2		2			1	4			00000010000000000000000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1						05/27/2022	2023.01	05/27/2022 11:07:17 AM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	801	0	2023	Select counties in Florida		1	35175	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 10:59:14 AM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	806	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						05/27/2022	2023.01	05/27/2022 11:11:08 AM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	810	0	2023	Select Counties in MS, OR and NC		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 01:29:24 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	811	0	2023	Select Counties in MS, OR and NC		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						05/27/2022	2023.01	05/27/2022 01:54:12 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	814	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 01:56:58 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	815	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						05/27/2022	2023.01	05/27/2022 02:07:25 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	816	0	2023	Select counties in MS, OR and NC		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 02:13:16 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	817	0	2023	Select counties in MS, OR and NC		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						05/27/2022	2023.01	05/27/2022 02:18:47 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	818	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 02:31:38 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	819	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						05/27/2022	2023.01	05/27/2022 02:31:21 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	820	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 02:36:09 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	821	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						05/27/2022	2023.01	05/27/2022 02:42:14 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	822	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 02:46:56 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	823	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						05/27/2022	2023.01	05/27/2022 02:51:41 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	824	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 02:55:29 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	825	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						05/27/2022	2023.01	05/27/2022 02:59:03 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	826	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/27/2022	2023.01	05/27/2022 03:04:22 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	827	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	828	0	1	01	01	H1036_828_0	2	1						06/03/2022	2023.01	06/03/2022 04:32:29 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	828	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	829	0	1	01	01	H1036_829_0	2	1				0	0	06/03/2022	2023.01	06/03/2022 04:40:49 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	829	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	830	0	1	01	01	H1036_830_0	4	1						06/05/2022	2023.01	06/05/2022 02:31:51 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	830	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	831	0	1	01	01	H1036_831_0	2	1				0	0	06/03/2022	2023.01	06/03/2022 04:49:03 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	831	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	832	0	1	01	01	H1036_832_0	2	1						06/03/2022	2023.01	06/03/2022 04:52:09 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	832	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	833	0	1	01	01	H1036_833_0	2	1				0	0	06/03/2022	2023.01	06/03/2022 04:54:36 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	833	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	834	0	1	01	01	H1036_834_0	2	1						06/03/2022	2023.01	06/03/2022 04:57:40 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	834	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	835	0	1	01	01	H1036_835_0	2	1				0	0	06/03/2022	2023.01	06/03/2022 05:00:27 PM Eastern Daylight Time					06/05/2022 02:32:59 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	835	0	2023	Select counties in Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						06/03/2022	2023.01	06/03/2022 02:58:45 PM Eastern Daylight Time		05/25/2022 08:14:38 PM Eastern Daylight Time			06/03/2022 03:02:11 PM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	miamijewishhealthsystems.org	Florida PACE Centers, Inc.	08	20		1			H1043	001	0	2023	Florida PACE Centers, Inc.		2		2			2									www.FloridaPACECenters.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						06/03/2022	2023.01	06/03/2022 02:59:48 PM Eastern Daylight Time		05/25/2022 08:17:19 PM Eastern Daylight Time			06/03/2022 03:02:11 PM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	miamijewishhealthsystems.org	Florida PACE Centers, Inc	08	20		1			H1043	002	0	2023	Florida PACE Centers, Inc.		2		2			2									www.FloridaPACECenters.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	2	1			2		1	08/03/2022	2023.01	08/03/2022 08:55:35 AM Central Daylight Time	08/03/2022 10:51:35 AM Central Daylight Time	07/31/2022 12:31:07 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Dade (HMO)	01	01		1			H1045	001	0	2023	Miami-Dade County		2		2			2									www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	005	0	1	01	01	H1045_005_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 08:56:23 AM Central Daylight Time	08/03/2022 10:52:14 AM Central Daylight Time	07/31/2022 12:31:32 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Broward (HMO)	01	01		1			H1045	005	0	2023	Broward County		2		2			2									www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	012	0	1	01	01	H1045_012_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 08:57:35 AM Central Daylight Time	08/03/2022 10:52:51 AM Central Daylight Time	07/31/2022 12:31:56 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Medicare Assist (HMO D-SNP)	01	01		1			H1045	012	0	2023	Miami-Dade and Broward Counties		2		2			1	3		2					2	www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	018	0	1	01	01	H1045_018_0	2	1		1	2		1	08/03/2022	2023.01	08/03/2022 08:57:56 AM Central Daylight Time	08/03/2022 10:53:29 AM Central Daylight Time	07/31/2022 12:32:20 AM Central Daylight Time			08/04/2022 01:20:30 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	2023	Miami-Dade County		2		2			1	4			00000000000000000010000					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	02	01	H1045_025_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 08:58:19 AM Central Daylight Time	08/03/2022 10:54:06 AM Central Daylight Time	07/31/2022 12:32:45 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages Medicare Advantage (HMO-POS)	01	02		1			H1045	025	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 08:58:49 AM Central Daylight Time	08/03/2022 10:54:42 AM Central Daylight Time	07/31/2022 12:33:09 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	026	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 08:59:11 AM Central Daylight Time	08/03/2022 10:55:21 AM Central Daylight Time	07/31/2022 12:33:33 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	028	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 08:59:27 AM Central Daylight Time	08/03/2022 10:55:58 AM Central Daylight Time	07/31/2022 12:33:57 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	030	0	2023	Select counties in 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	031	0	1	02	01	H1045_031_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:01:00 AM Central Daylight Time	08/03/2022 10:56:37 AM Central Daylight Time	07/31/2022 12:34:21 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	031	0	2023	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	033	0	1	02	01	H1045_033_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:01:25 AM Central Daylight Time	08/03/2022 10:57:15 AM Central Daylight Time	07/31/2022 12:34:45 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	033	0	2023	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	02	01	H1045_034_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:01:55 AM Central Daylight Time	08/03/2022 10:57:54 AM Central Daylight Time	07/31/2022 12:35:09 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H1045	034	0	2023	Select counties in Fort Myers/Naples		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	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:02:22 AM Central Daylight Time	08/03/2022 10:58:31 AM Central Daylight Time	07/31/2022 12:35:33 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H1045	036	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:03:45 AM Central Daylight Time	08/03/2022 10:59:09 AM Central Daylight Time	07/31/2022 12:35:57 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Palm Beach (HMO)	01	01		1			H1045	037	0	2023	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	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:04:59 AM Central Daylight Time	08/03/2022 10:59:45 AM Central Daylight Time	07/31/2022 12:36:22 AM Central Daylight Time			08/04/2022 01:20:30 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	2023	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	02	01	H1045_039_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:06:10 AM Central Daylight Time	08/03/2022 11:00:22 AM Central Daylight Time	07/31/2022 12:36:47 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO-POS D-SNP)	01	02		1			H1045	039	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:07:40 AM Central Daylight Time	08/03/2022 11:00:59 AM Central Daylight Time	07/31/2022 12:37:11 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	041	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:08:08 AM Central Daylight Time	08/03/2022 11:01:36 AM Central Daylight Time	07/31/2022 12:37:35 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	042	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:08:46 AM Central Daylight Time	08/03/2022 11:02:13 AM Central Daylight Time	07/31/2022 12:38:00 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Premier (HMO-POS)	01	02		1			H1045	043	0	2023	Citrus, Levy, and Hernando 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	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:09:11 AM Central Daylight Time	08/03/2022 11:02:50 AM Central Daylight Time	07/31/2022 12:38:24 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H1045	045	0	2023	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	02	01	H1045_048_1	2	1		1	2		1	08/03/2022	2023.01	08/03/2022 09:09:32 AM Central Daylight Time	08/03/2022 11:03:27 AM Central Daylight Time	07/31/2022 12:38:48 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO-POS C-SNP)	01	02		1			H1045	048	1	2023	Select counties in Florida	Orlando Metro	2		2			1	4			00000000000000000010000					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	02	01	H1045_048_2	2	1		1	2		1	08/03/2022	2023.01	08/03/2022 09:10:01 AM Central Daylight Time	08/03/2022 11:04:04 AM Central Daylight Time	07/31/2022 12:39:13 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO-POS C-SNP)	01	02		1			H1045	048	2	2023	Select counties in Florida	Southwest Florida	2		2			1	4			00000000000000000010000					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	02	01	H1045_048_3	2	1		1	2		1	08/03/2022	2023.01	08/03/2022 09:10:14 AM Central Daylight Time	08/03/2022 11:04:41 AM Central Daylight Time	07/31/2022 12:39:37 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO-POS C-SNP)	01	02		1			H1045	048	3	2023	Select counties in Florida	Tampa Metro	2		2			1	4			00000000000000000010000					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	02	01	H1045_048_4	2	1		1	2		1	08/03/2022	2023.01	08/03/2022 09:10:30 AM Central Daylight Time	08/03/2022 11:05:17 AM Central Daylight Time	07/31/2022 12:40:01 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO-POS C-SNP)	01	02		1			H1045	048	4	2023	Select counties in Florida	Lake, Marion & Sumter Counties	2		2			1	4			00000000000000000010000					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	055	0	1	02	01	H1045_055_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:10:56 AM Central Daylight Time	08/03/2022 11:05:54 AM Central Daylight Time	07/31/2022 12:40:25 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	055	0	2023	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	056	0	1	02	01	H1045_056_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:11:21 AM Central Daylight Time	08/03/2022 11:06:31 AM Central Daylight Time	07/31/2022 12:40:50 AM Central Daylight Time			08/04/2022 01:20:30 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages Medicare Focus (HMO-POS)	01	02		1			H1045	056	0	2023	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	801	0	1	01	01	H1045_801_0	1	1						06/03/2022	2023.01	06/03/2022 09:52:45 AM Central Daylight Time					06/03/2022 02:39:23 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	801	0	2023	Select counties in Florida		1	240	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	06/03/2022	2023.01	06/03/2022 09:53:06 AM Central Daylight Time					06/03/2022 02:39:23 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	802	0	2023	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						06/03/2022	2023.01	06/03/2022 09:53:18 AM Central Daylight Time					06/03/2022 02:39:23 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	803	0	2023	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						06/03/2022	2023.01	06/03/2022 09:53:30 AM Central Daylight Time					06/03/2022 02:39:23 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1045	804	0	2023	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	6	1					1	07/25/2022	2023.01	07/25/2022 08:48:34 AM Eastern Daylight Time	08/03/2022 05:19:21 PM Eastern Daylight Time	08/03/2022 05:19:22 PM Eastern Daylight Time			08/03/2022 05:25:32 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	2023	Counties: BR, IR		2		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	5	1					1	07/18/2022	2023.01	07/18/2022 02:43:53 PM Eastern Daylight Time	08/03/2022 05:19:22 PM Eastern Daylight Time	08/03/2022 05:19:22 PM Eastern Daylight Time			08/03/2022 05:25:32 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	2023	Counties: BR, IR		2		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	4	1				0	0	07/18/2022	2023.01	07/18/2022 02:44:18 PM Eastern Daylight Time	06/06/2022 03:49:18 PM Eastern Daylight Time				07/18/2022 08:24:18 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	2023	Counties: BR, IR		2		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	5	1					1	07/18/2022	2023.01	07/18/2022 02:44:29 PM Eastern Daylight Time	08/03/2022 05:19:22 PM Eastern Daylight Time	08/03/2022 05:19:22 PM Eastern Daylight Time			08/03/2022 05:25:32 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	2023	Counties: BR, IR		2		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	5	1					1	07/18/2022	2023.01	07/18/2022 02:44:42 PM Eastern Daylight Time	08/03/2022 05:19:22 PM Eastern Daylight Time	08/03/2022 05:19:22 PM Eastern Daylight Time			08/03/2022 05:25:32 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myHFHP.org	Health First Sunsaver Plan (HMO)	01	01		1			H1099	016	0	2023	Counties: VO, FL, HA, HI		2		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			
H1109	005	0	1	01	01	H1109_005_0	3	1					1	08/02/2022	2023.01	08/02/2022 05:14:55 PM Eastern Daylight Time	08/03/2022 11:52:11 AM Eastern Daylight Time	07/31/2022 08:56:34 PM Eastern Daylight Time			08/04/2022 04:25:53 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1109	005	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 09:27:26 PM Eastern Daylight Time	08/03/2022 11:53:32 AM Eastern Daylight Time	07/31/2022 08:57:00 PM Eastern Daylight Time			08/04/2022 04:25:53 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1109	006	0	2023	Hall 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	2			
H1109	801	0	1	01	01	H1109_801_0	1	1				0	0	05/27/2022	2023.01	05/27/2022 08:58:05 AM Eastern Daylight Time					06/02/2022 02:42:54 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H1109	801	0	2023	Georgia		1	1350	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H1109	802	0	1	01	01	H1109_802_0	2	1						05/27/2022	2023.01	05/27/2022 08:59:09 AM Eastern Daylight Time					06/02/2022 06:19:01 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	2023	Georgia		1	3990	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H1111	011	0	1	02	01	H1111_011_0	2	1					1	08/02/2022	2023.01	08/02/2022 03:33:00 PM Central Daylight Time	08/03/2022 11:17:20 AM Central Daylight Time	07/31/2022 12:41:14 AM Central Daylight Time			08/04/2022 03:39:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO-POS)	01	02		1			H1111	011	0	2023	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						06/03/2022	2023.01	06/03/2022 09:54:06 AM Central Daylight Time					06/03/2022 02:42:10 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	801	0	2023	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	06/03/2022	2023.01	06/03/2022 09:54:24 AM Central Daylight Time					06/03/2022 02:42:10 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	804	0	2023	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						06/03/2022	2023.01	06/03/2022 09:54:42 AM Central Daylight Time					06/03/2022 02:42:10 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	805	0	2023	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						06/03/2022	2023.01	06/03/2022 09:54:57 AM Central Daylight Time					06/03/2022 02:42:10 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1111	807	0	2023	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	5	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 11:50:42 AM Eastern Daylight Time	08/03/2022 07:39:24 PM Central Daylight Time	07/30/2022 07:07:13 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1112	006	0	2023	Select counties in GA		2		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	5	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 11:51:47 AM Eastern Daylight Time	08/03/2022 07:40:59 PM Central Daylight Time	07/30/2022 07:07:45 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1112	033	0	2023	Select counties in GA		2		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	3	1				0	0	05/26/2022	2023.01	05/26/2022 11:23:37 AM Eastern Daylight Time	06/03/2022 05:44:04 PM Central Daylight Time				07/15/2022 03:18:19 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO-POS)	01	02		1			H1112	034	0	2023	Select counties in GA		2		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	038	0	1	01	01	H1112_038_0	4	1						08/01/2022	2023.01	08/01/2022 11:41:11 AM Eastern Daylight Time	08/03/2022 07:42:34 PM Central Daylight Time	07/30/2022 07:08:16 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1112	038	0	2023	Select counties in GA		2		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						08/03/2022	2023.01	08/03/2022 03:10:39 PM Eastern Daylight Time	08/03/2022 07:44:13 PM Central Daylight Time	07/30/2022 07:08:48 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1112	039	0	2023	Select counties in GA		2		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						08/01/2022	2023.01	08/01/2022 11:46:35 AM Eastern Daylight Time	08/03/2022 07:45:47 PM Central Daylight Time	07/30/2022 07:09:19 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Focus (HMO)	01	01		1			H1112	040	0	2023	Select counties in GA		2		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						08/03/2022	2023.01	08/03/2022 03:11:39 PM Eastern Daylight Time	08/03/2022 07:47:23 PM Central Daylight Time	07/30/2022 07:09:50 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1112	042	0	2023	Select counties in GA		2		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			2			05/26/2022	2023.01	05/26/2022 11:30:34 AM Eastern Daylight Time	08/03/2022 07:49:01 PM Central Daylight Time	07/30/2022 07:10:22 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H1112	043	0	2023	Select counties in GA		2		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						08/01/2022	2023.01	08/01/2022 11:47:52 AM Eastern Daylight Time	08/03/2022 07:50:36 PM Central Daylight Time	07/30/2022 07:10:54 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1112	044	0	2023	Select counties in GA		2		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	805	0	1	01	01	H1112_805_0	1	1						05/10/2022	2023.01	05/10/2022 09:47:09 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Group Medicare Advantage (HMO)	01	01		1			H1112	805	0	2023	Select Counties in Georgia		1	100	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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H1112	806	0	1	01	01	H1112_806_0	1	1						05/10/2022	2023.01	05/10/2022 09:51:12 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Group Medicare Advantage (HMO)	01	01		1			H1112	806	0	2023	Select Counties in Georgia		1	100	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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H1112	807	0	1	01	01	H1112_807_0	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:51:17 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Group Medicare Advantage (HMO)	01	01		1			H1112	807	0	2023	Select Counties in Georgia		1	100	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)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H1119	001	0	1	01	01	H1119_001_0	3	1		1				08/04/2022	2023.01	08/04/2022 08:27:58 AM Eastern Daylight Time	08/04/2022 01:30:48 PM Eastern Daylight Time	08/04/2022 01:30:48 PM Eastern Daylight Time			08/04/2022 01:32:47 PM Eastern Daylight Time	TSG GUARD, INC.	Valor Health Plan	www.valorhealthplan.com	Valor Health Plan (HMO I-SNP)	01	01		1			H1119	001	0	2023	Select Counties in Ohio		2		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	10	1						08/04/2022	2023.01	08/04/2022 02:26:26 PM Eastern Daylight Time	08/03/2022 10:00:47 AM Eastern Daylight Time	08/03/2022 10:09:29 AM Eastern Daylight Time			08/04/2022 05:39:44 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	2023	Atlanta Metro Area		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(800)232-4404		(404)233-3700		(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	10	1	2	1			0	07/20/2022	2023.01	07/20/2022 04:13:42 PM Eastern Daylight Time	08/03/2022 10:02:03 AM Eastern Daylight Time	08/03/2022 10:12:18 AM Eastern Daylight Time			08/04/2022 05:39:44 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	2023	Atlanta Metro Area		2		2			1	3		2					2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(800)232-4404		(404)233-3700		(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	10	1						08/04/2022	2023.01	08/04/2022 01:47:02 PM Eastern Daylight Time	08/03/2022 10:01:26 AM Eastern Daylight Time	08/03/2022 10:11:00 AM Eastern Daylight Time			08/04/2022 05:39:44 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	2023	Atlanta Metro Area		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(800)232-4404		(404)233-3700		(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	10	1						08/04/2022	2023.01	08/04/2022 02:26:56 PM Eastern Daylight Time	08/03/2022 10:02:37 AM Eastern Daylight Time	08/03/2022 10:13:36 AM Eastern Daylight Time			08/04/2022 05:39:44 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	2023	Barrow, Butts, Newton, Rockdale, Spalding, Walton		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(800)232-4404		(404)233-3700		(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	07/20/2022	2023.01	07/20/2022 04:38:54 PM Eastern Daylight Time	08/03/2022 10:03:46 AM Eastern Daylight Time	08/03/2022 10:16:15 AM Eastern Daylight Time			08/04/2022 05:39:44 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	2023	Barrow, Butts, Newton, Rockdale, Spalding, Walton		2		2			1	3		2					2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(800)232-4404		(404)233-3700		(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	9	1						08/04/2022	2023.01	08/04/2022 02:25:27 PM Eastern Daylight Time	08/03/2022 10:03:12 AM Eastern Daylight Time	08/03/2022 10:14:56 AM Eastern Daylight Time			08/04/2022 05:39:44 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	2023	Barrow, Butts, Newton, Rockdale, Spalding, Walton		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	013	0	1	02	01	H1170_013_0	10	1						08/04/2022	2023.01	08/04/2022 02:31:38 PM Eastern Daylight Time	08/03/2022 10:04:22 AM Eastern Daylight Time	08/03/2022 10:17:28 AM Eastern Daylight Time			08/04/2022 05:39:44 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Care Plus (HMO-POS)	01	02		1			H1170	013	0	2023	Atlanta Metro Area		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	014	0	1	01	01	H1170_014_0	8	1				0	0	07/20/2022	2023.01	07/20/2022 04:40:59 PM Eastern Daylight Time	06/05/2022 02:28:45 PM Eastern Daylight Time				07/20/2022 06:21:18 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Liberty (HMO)	01	01		1			H1170	014	0	2023	Atlanta Full Metro Area		2		2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1170	801	0	1	01	01	H1170_801_0	2	1				0	0	05/31/2022	2023.01	05/31/2022 03:23:43 PM Eastern Daylight Time					06/03/2022 04:35:35 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	2023	Atlanta Metro Area		1	0	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(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	2	1						05/23/2022	2023.01	05/23/2022 05:10:02 PM Eastern Daylight Time					06/03/2022 04:35:35 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	2023	Atlanta Metro Area		1	60435	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(800)232-4404		(404)233-3700		(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	2	1						05/23/2022	2023.01	05/23/2022 04:51:01 PM Eastern Daylight Time					06/03/2022 04:35:35 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	2023	Atlanta Metro Area		1	26703	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(404)233-3700		(877)408-3493		(877)408-3493		(800)232-4404		(404)233-3700		(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	4	2				0	0	06/02/2022	2023.01	06/02/2022 11:26:33 AM Eastern Daylight Time			06/02/2022 08:45:04 PM Central Daylight Time		06/03/2022 08:50:32 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	NetworkPrime (MSA)	02	07	2				H1181	001	0	2023	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	002	0	1	01	01	H1189_002_0	5	1						08/04/2022	2023.01	08/04/2022 08:14:19 AM Pacific Daylight Time	08/04/2022 09:32:48 AM Pacific Daylight Time	08/01/2022 11:56:45 AM Pacific Daylight Time			08/04/2022 12:03:31 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	2023	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	4	1						08/03/2022	2023.01	08/03/2022 09:35:45 AM Pacific Daylight Time	08/04/2022 09:33:31 AM Pacific Daylight Time	08/01/2022 11:57:18 AM Pacific Daylight Time			08/04/2022 12:03:31 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	2023	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	4	1						08/03/2022	2023.01	08/03/2022 09:35:57 AM Pacific Daylight Time	08/04/2022 09:34:46 AM Pacific Daylight Time	08/01/2022 11:57:50 AM Pacific Daylight Time			08/04/2022 12:03:31 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	2023	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	4	1						08/03/2022	2023.01	08/03/2022 09:36:10 AM Pacific Daylight Time	08/04/2022 09:35:37 AM Pacific Daylight Time	08/01/2022 11:58:24 AM Pacific Daylight Time			08/04/2022 12:03:31 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	2023	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	3	1				0	0	06/03/2022	2023.01	06/03/2022 02:45:44 PM Pacific Daylight Time	06/06/2022 04:02:20 PM Pacific Daylight Time				06/06/2022 05:54:45 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	2023	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	06/30/2022	2023.01	06/30/2022 03:01:35 PM Pacific Daylight Time	06/06/2022 04:02:46 PM Pacific Daylight Time				07/01/2022 02:14:29 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	2023	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	1	10		13a;
H1189	008	0	1	01	01	H1189_008_0	3	1				0	0	06/03/2022	2023.01	06/03/2022 02:46:44 PM Pacific Daylight Time	06/06/2022 04:03:51 PM Pacific Daylight Time				06/06/2022 05:54:45 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	2023	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			
H1189	009	0	1	01	01	H1189_009_0	4	1						08/03/2022	2023.01	08/03/2022 09:37:13 AM Pacific Daylight Time	08/04/2022 09:36:41 AM Pacific Daylight Time	08/01/2022 11:58:56 AM Pacific Daylight Time			08/04/2022 12:03:31 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	009	0	2023	Southcentral 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	010	0	1	01	01	H1189_010_0	4	1						08/03/2022	2023.01	08/03/2022 09:37:26 AM Pacific Daylight Time	08/04/2022 09:37:15 AM Pacific Daylight Time	08/01/2022 11:59:29 AM Pacific Daylight Time			08/04/2022 12:03:31 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	010	0	2023	East 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			
H1215	001	0	1	01	01	H1215_001_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 10:56:46 AM Eastern Daylight Time	08/03/2022 07:53:57 PM Eastern Daylight Time	07/30/2022 08:11:26 AM Eastern Daylight Time			08/04/2022 06:10:56 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcareNE.com	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1215	001	0	2023	Select counties in NE		2		2			1	3		1					1	www.wellcareNE.com	www.wellcareNE.com	www.wellcareNE.com	(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	4	1						08/01/2022	2023.01	08/01/2022 12:49:26 PM Eastern Daylight Time	08/03/2022 07:55:10 PM Eastern Daylight Time	07/30/2022 08:11:57 AM Eastern Daylight Time			08/04/2022 06:10:56 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcareNE.com	Wellcare No Premium (HMO)	01	01		1			H1215	002	0	2023	Select counties in NE		2		2			2									www.wellcareNE.com	www.wellcareNE.com	www.wellcareNE.com	(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	4	1						05/25/2022	2023.01	05/25/2022 05:56:12 PM Eastern Daylight Time	08/03/2022 07:56:21 PM Eastern Daylight Time	07/30/2022 08:12:28 AM Eastern Daylight Time			08/04/2022 06:10:56 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcareNE.com	Wellcare Giveback (HMO)	01	01		1			H1215	003	0	2023	Select counties in NE		2		2			2									www.wellcareNE.com	www.wellcareNE.com	www.wellcareNE.com	(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			
H1224	001	0	1	01	01	H1224_001_0	12	1	2	1			0	08/02/2022	2023.01	08/02/2022 02:31:53 PM Pacific Daylight Time	08/08/2022 01:25:00 PM Pacific Daylight Time	08/03/2022 08:15:00 AM Pacific Daylight Time			08/10/2022 07:33:45 AM Pacific Daylight Time	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	L.A. Care Health Plan	medicare.lacare.org	L.A. Care Medicare Plus (HMO D-SNP)	01	01		1			H1224	001	0	2023	Los Angeles County		2		2			1	3		2					2	medicare.lacare.org	medicare.lacare.org	www.lacare.org	(833)522-3767		(833)522-3767		(833)592-3767		(833)592-3767		(833)522-3767		(833)522-3767		(833)592-3767		(833)592-3767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1225	001	0	1	01	01	H1225_001_0	11	1					1	08/04/2022	2023.01	08/04/2022 08:30:27 AM Eastern Daylight Time	08/04/2022 10:27:41 AM Eastern Daylight Time	08/04/2022 10:27:41 AM Eastern Daylight Time			08/04/2022 11:40:10 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins Advantage MD	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD (HMO)	01	01		1			H1225	001	0	2023	Counties: AA BL CR FR HW MG SS WH WC WR		2		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	10	1	2	1			0	08/04/2022	2023.01	08/04/2022 08:32:39 AM Eastern Daylight Time	08/04/2022 10:27:41 AM Eastern Daylight Time	08/04/2022 10:27:41 AM Eastern Daylight Time			08/04/2022 11:41:58 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins Advantage MD	www.hopkinsmedicare.com	Johns Hopkins Advantage MD D-SNP (HMO D-SNP)	01	01		1			H1225	003	0	2023	Anne Arundel, Howard and Montgomery Counties		2		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			
H1225	004	0	1	01	01	H1225_004_0	9	1				0	0	07/17/2022	2023.01	07/17/2022 07:57:23 PM Eastern Daylight Time	06/04/2022 08:15:16 PM Eastern Daylight Time				07/18/2022 08:47:01 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins Advantage MD	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD Tribute (HMO)	01	01		1			H1225	004	0	2023	AA BL FR HW MO		2		2			2									www.hopkinsmedicare.com/	www.hopkinsmedicare.com/	www.hopkinsmedicare.com/	(877)293-4998		(877)293-4998		(888)403-7682		(888)403-7682										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1228	001	0	1	20	08	H1228_001_0	1	1						06/01/2022	2023.01	06/01/2022 12:23:17 PM Pacific Daylight Time		06/01/2022 12:28:13 PM Pacific Daylight Time			06/01/2022 12:31:17 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	2023	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						06/01/2022	2023.01	06/01/2022 12:23:26 PM Pacific Daylight Time		06/01/2022 12:28:13 PM Pacific Daylight Time			06/01/2022 12:31:17 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	2023	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	6	1						05/26/2022	2023.01	05/26/2022 04:46:53 PM Hawaiian Standard Time	08/01/2022 10:34:46 AM Hawaiian Standard Time	08/01/2022 10:30:29 AM Hawaiian Standard Time			08/03/2022 04:21:58 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	01	01		1			H1230	001	0	2023	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	6	1						05/31/2022	2023.01	05/31/2022 11:37:50 AM Hawaiian Standard Time	08/01/2022 10:35:08 AM Hawaiian Standard Time	08/01/2022 10:31:20 AM Hawaiian Standard Time			08/03/2022 04:21:58 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H1230	003	0	2023	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	6	1	2	1			0	05/12/2022	2023.01	05/12/2022 03:40:41 PM Hawaiian Standard Time	08/01/2022 10:36:28 AM Hawaiian Standard Time	08/01/2022 10:33:39 AM Hawaiian Standard Time			08/03/2022 04:21:58 PM 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	2023	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	6	1						05/26/2022	2023.01	05/26/2022 04:46:29 PM Hawaiian Standard Time	08/01/2022 10:35:35 AM Hawaiian Standard Time	08/01/2022 10:32:07 AM Hawaiian Standard Time			08/03/2022 04:21:58 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Maui (HMO)	01	01		1			H1230	013	0	2023	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	6	1						05/26/2022	2023.01	05/26/2022 04:46:05 PM Hawaiian Standard Time	08/01/2022 10:36:03 AM Hawaiian Standard Time	08/01/2022 10:32:54 AM Hawaiian Standard Time			08/03/2022 04:21:58 PM 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	2023	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	2	1				0	0	05/11/2022	2023.01	05/11/2022 03:30:07 PM Hawaiian Standard Time					06/03/2022 01:41:45 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	2023	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	1010	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)220-3957		(877)220-3957										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;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;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;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					2				
H1230	803	0	1	01	01	H1230_803_0	2	1						05/11/2022	2023.01	05/11/2022 03:30:25 PM Hawaiian Standard Time					06/03/2022 01:41:45 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	2023	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	168998	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)220-3957		(877)220-3957		(800)805-2739		(800)805-2739		(877)220-3957		(877)220-3957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;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;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;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					2				
H1230	804	0	2	01	01	H1230_804_0	2	1						05/03/2022	2023.01	05/03/2022 07:00:20 PM Hawaiian Standard Time					06/03/2022 01:41:45 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	2023	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	337	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)220-3957		(877)220-3957		(800)805-2739		(800)805-2739		(877)220-3957		(877)220-3957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;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;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;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					2				
H1230	805	0	1	01	01	H1230_805_0	2	1						05/03/2022	2023.01	05/03/2022 07:00:41 PM Hawaiian Standard Time					06/03/2022 01:41:45 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H1230	805	0	2023	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	23250	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)220-3957		(877)220-3957		(800)805-2739		(800)805-2739		(877)220-3957		(877)220-3957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;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;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;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					2				
H1230	806	0	2	01	01	H1230_806_0	2	1						05/03/2022	2023.01	05/03/2022 07:00:58 PM Hawaiian Standard Time					06/03/2022 01:41:45 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	2023	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	59	2			2									kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)220-3957		(877)220-3957		(800)805-2739		(800)805-2739		(877)220-3957		(877)220-3957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;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;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;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					2				
H1234	001	0	1	20	08	H1234_001_0	1	1						05/27/2022	2023.01	05/27/2022 10:50:31 AM Eastern Daylight Time		05/27/2022 10:06:42 AM Eastern Daylight Time			05/31/2022 08:45:03 AM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Dual (PACE)	08	20		1			H1234	001	0	2023	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						05/27/2022	2023.01	05/27/2022 10:51:13 AM Eastern Daylight Time		05/27/2022 10:06:46 AM Eastern Daylight Time			05/31/2022 08:45:03 AM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Medicare only (PACE)	08	20		1			H1234	002	0	2023	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						06/02/2022	2023.01	06/02/2022 09:55:32 AM Mountain Daylight Time		05/27/2022 06:14:08 PM Mountain Daylight Time			06/02/2022 09:56:27 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	2023	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						06/02/2022	2023.01	06/02/2022 09:55:45 AM Mountain Daylight Time		05/27/2022 06:16:04 PM Mountain Daylight Time			06/02/2022 09:56:27 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	2023	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	004	0	1	04	01	H1248_004_0	7	1						08/09/2022	2023.01	08/09/2022 08:49:56 AM Central Daylight Time	08/04/2022 12:12:14 PM Central Daylight Time	08/03/2022 03:49:46 PM Central Daylight Time			08/09/2022 03:54:51 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	004	0	2023	State of Louisiana		2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	007	0	1	04	01	H1248_007_0	7	1						08/09/2022	2023.01	08/09/2022 08:50:59 AM Central Daylight Time	08/04/2022 12:13:00 PM Central Daylight Time	08/03/2022 03:50:18 PM Central Daylight Time			08/09/2022 03:54:51 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	007	0	2023	Baton Rouge, Surrounding Areas		2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	801	0	1	04	01	H1248_801_0	3	1						05/27/2022	2023.01	05/27/2022 11:30:28 AM Central Daylight Time					06/01/2022 10:04:17 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	801	0	2023	State of Louisiana		1	70319	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	802	0	1	04	01	H1248_802_0	3	1						05/27/2022	2023.01	05/27/2022 11:27:04 AM Central Daylight Time					06/01/2022 10:04:17 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	802	0	2023	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)-		2					2						2			
H1248	803	0	1	04	01	H1248_803_0	3	1				0	0	05/27/2022	2023.01	05/27/2022 11:28:10 AM Central Daylight Time					06/01/2022 10:04:17 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	803	0	2023	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)-										2					2						2			
H1277	001	0	1	01	01	H1277_001_0	5	1		1			1	08/09/2022	2023.01	08/09/2022 01:23:40 PM Eastern Daylight Time	08/05/2022 09:48:04 AM Eastern Daylight Time	08/05/2022 07:17:34 AM Eastern Daylight Time			08/10/2022 12:03:24 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	2023	Virginia (partial)		2		2			1	1	3							www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1277	002	0	1	01	01	H1277_002_0	5	1		1			1	08/09/2022	2023.01	08/09/2022 01:24:34 PM Eastern Daylight Time	08/05/2022 09:48:32 AM Eastern Daylight Time	08/05/2022 07:17:52 AM Eastern Daylight Time			08/10/2022 12:03:24 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	2023	Virginia (partial)		2		2			1	4			00000100000000000000000					www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1277	003	0	1	01	01	H1277_003_0	5	1		1			0	08/04/2022	2023.01	08/04/2022 09:27:20 PM Eastern Daylight Time	08/05/2022 07:49:00 AM Mountain Daylight Time	08/05/2022 05:18:11 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	ALIGN SENIOR CARE, INC.	Align Senior Care	www.alignseniorcare.com	Align Senior Care Mass (HMO I-SNP)	01	01		1			H1277	003	0	2023	Massachusetts (partial)		2		2			1	1	3							www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1277	004	0	1	01	01	H1277_004_0	8	1		1			1	08/09/2022	2023.01	08/09/2022 02:49:40 PM Eastern Daylight Time		08/04/2022 04:01:50 PM Eastern Daylight Time		08/04/2022 03:40:37 PM Eastern Daylight Time	08/19/2022 07:11:04 PM Eastern Daylight Time	ALIGN SENIOR CARE, INC.	Align Senior Care	www.alignseniorcare.com	Align Kidney Care (HMO C-SNP)	01	01		1			H1277	004	0	2023	Virginia (partial)		2		2			1	4			00000000100000000000000					www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1277	005	0	1	02	01	H1277_005_0	5	1					1	08/04/2022	2023.01	08/04/2022 09:31:32 PM Eastern Daylight Time	08/05/2022 07:49:27 AM Mountain Daylight Time	08/05/2022 05:18:29 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	ALIGN SENIOR CARE, INC.	Align Senior Care	www.alignseniorcare.com	Align Senior Care MAPD (HMO-POS)	01	02		1			H1277	005	0	2023	Virginia (partial)		2		2			2									www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(855)855-0489		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1278	001	0	1	04	01	H1278_001_0	4	1					1	08/05/2022	2023.01	08/05/2022 10:57:34 AM Central Daylight Time	08/03/2022 11:21:22 AM Central Daylight Time	07/31/2022 12:41:38 AM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H1278	001	0	2023	Select Counties in IA and NE		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			
H1278	003	0	1	04	01	H1278_003_0	3	1					1	08/03/2022	2023.01	08/03/2022 05:36:56 PM Central Daylight Time	08/03/2022 11:22:00 AM Central Daylight Time	07/31/2022 12:42:02 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	003	0	2023	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	08/03/2022	2023.01	08/03/2022 05:37:08 PM Central Daylight Time	08/03/2022 11:22:37 AM Central Daylight Time	07/31/2022 12:42:27 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H1278	004	0	2023	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	08/03/2022	2023.01	08/03/2022 05:37:20 PM Central Daylight Time	08/03/2022 11:23:17 AM Central Daylight Time	07/31/2022 12:42:51 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	005	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 10:58:21 AM Central Daylight Time	08/03/2022 11:23:54 AM Central Daylight Time	07/31/2022 12:43:15 AM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	007	0	2023	Sioux Falls 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						2			
H1278	009	0	1	04	01	H1278_009_0	4	1					1	08/05/2022	2023.01	08/05/2022 10:58:28 AM Central Daylight Time	08/03/2022 11:24:31 AM Central Daylight Time	07/31/2022 12:43:39 AM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	009	0	2023	Rapid City 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						2			
H1278	010	0	1	04	01	H1278_010_0	3	1					1	08/03/2022	2023.01	08/03/2022 05:37:33 PM Central Daylight Time	08/03/2022 11:25:08 AM Central Daylight Time	07/31/2022 12:44:03 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	010	0	2023	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	08/03/2022	2023.01	08/03/2022 05:37:46 PM Central Daylight Time	08/03/2022 11:25:47 AM Central Daylight Time	07/31/2022 12:44:28 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	013	0	2023	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	08/03/2022	2023.01	08/03/2022 05:37:57 PM Central Daylight Time	08/03/2022 11:26:25 AM Central Daylight Time	07/31/2022 12:44:52 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	014	0	2023	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	08/03/2022	2023.01	08/03/2022 05:38:08 PM Central Daylight Time	08/03/2022 11:27:02 AM Central Daylight Time	07/31/2022 12:45:16 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	015	0	2023	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	08/03/2022	2023.01	08/03/2022 05:38:20 PM Central Daylight Time	08/03/2022 11:27:40 AM Central Daylight Time	07/31/2022 12:45:40 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	016	0	2023	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	3	1				0	0	06/01/2022	2023.01	06/01/2022 08:12:43 AM Central Daylight Time	06/01/2022 10:59:19 AM Central Daylight Time				06/02/2022 12:49:37 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H1278	018	0	2023	Select Counties in Iowa and Nebraska		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			
H1278	019	0	1	04	01	H1278_019_0	1	1				0	0	06/01/2022	2023.01	06/01/2022 08:15:22 AM Central Daylight Time	06/01/2022 10:59:57 AM Central Daylight Time				06/02/2022 12:49:37 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H1278	019	0	2023	Select Counties in IA, NE, MN, and SD		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			
H1278	020	0	1	04	01	H1278_020_0	4	1					1	08/05/2022	2023.01	08/05/2022 10:58:40 AM Central Daylight Time	08/03/2022 11:28:16 AM Central Daylight Time	07/31/2022 12:46:04 AM Central Daylight Time			08/05/2022 11:46:05 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H1278	020	0	2023	Select Counties in Iowa and Nebraska		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			
H1280	001	0	1	01	01	H1280_001_0	6	1					1	08/05/2022	2023.01	08/05/2022 02:49:24 PM Central Daylight Time	08/03/2022 04:33:46 PM Eastern Daylight Time	08/03/2022 04:29:27 PM Eastern Daylight Time			08/05/2022 10:26:27 PM Eastern Daylight Time	ETERNALHEALTH,INC.	eternalHealth	https://www.eternalhealth.com/	eternalHealth Forever (HMO)	01	01		1			H1280	001	0	2023	Middlesex, Suffolk and Worcester Counties		2		2			2									https://www.optumrx.com/oe_rxexternal/pharmacy-locator?type=PDPClientPharmacy&var=MDETH122OE&infoid=	https://www.optumrx.com/oe_rxexternal/prescription-drug-list?type=PDPClientFormulary&var=X2022EXEGO&	www.eternalHealth.com	(800)680-4568		(617)684-2348		(800)840-5431		(800)840-5431		(800)891-6989		(800)891-6989		(800)840-5431		(800)840-5431		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1280	002	0	1	01	01	H1280_002_0	6	1					1	08/03/2022	2023.01	08/03/2022 04:07:31 PM Central Daylight Time	08/03/2022 04:34:40 PM Eastern Daylight Time	08/03/2022 04:30:16 PM Eastern Daylight Time			08/05/2022 10:26:27 PM Eastern Daylight Time	ETERNALHEALTH,INC.	eternalHealth	https://www.eternalhealth.com/	eternalHealth ForeverMore (HMO)	01	01		1			H1280	002	0	2023	Middlesex, Suffolk and Worcester Counties		2		2			2									https://www.optumrx.com/oe_rxexternal/pharmacy-locator?type=PDPClientPharmacy&var=MDETH122OE&infoid=	https://www.optumrx.com/oe_rxexternal/prescription-drug-list?type=PDPClientFormulary&var=X2022EXEGO&	www.eternalHealth.com	(800)680-4568		(617)684-2348		(800)840-5431		(800)840-5431		(800)891-6989		(800)891-6989		(800)840-5431		(800)840-5431		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	001	0	1	01	01	H1290_001_0	10	1			1		1	08/03/2022	2023.01	08/03/2022 07:59:30 AM US Eastern Daylight Time	08/04/2022 09:30:17 AM Eastern Daylight Time	07/31/2022 01:26:33 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Miami-Dade (HMO)	01	01		1			H1290	001	0	2023	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	08/03/2022	2023.01	08/03/2022 08:00:18 AM US Eastern Daylight Time	08/04/2022 09:30:43 AM Eastern Daylight Time	07/31/2022 01:26:57 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Broward (HMO)	01	01		1			H1290	002	0	2023	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	08/03/2022	2023.01	08/03/2022 08:00:44 AM US Eastern Daylight Time	08/04/2022 09:31:08 AM Eastern Daylight Time	07/31/2022 01:27:18 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Palm Beach (HMO)	01	01		1			H1290	003	0	2023	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	08/03/2022	2023.01	08/03/2022 08:01:11 AM US Eastern Daylight Time	08/04/2022 09:31:34 AM Eastern Daylight Time	07/31/2022 01:27:40 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Orlando (HMO)	01	01		1			H1290	005	0	2023	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	11	1			1		1	08/03/2022	2023.01	08/03/2022 08:02:00 AM US Eastern Daylight Time	08/04/2022 09:32:00 AM Eastern Daylight Time	07/31/2022 01:28:01 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS Miami-Dade (HMO)	01	01		1			H1290	013	0	2023	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	11	1			1		1	08/03/2022	2023.01	08/03/2022 02:59:06 PM US Eastern Daylight Time	08/04/2022 09:32:26 AM Eastern Daylight Time	07/31/2022 01:28:23 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS Broward (HMO)	01	01		1			H1290	014	0	2023	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	11	1			1		1	08/03/2022	2023.01	08/03/2022 08:03:22 AM US Eastern Daylight Time	08/04/2022 09:32:52 AM Eastern Daylight Time	07/31/2022 01:28:45 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS Palm Beach (HMO)	01	01		1			H1290	015	0	2023	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	018	0	1	01	01	H1290_018_0	11	1			1		1	08/03/2022	2023.01	08/03/2022 08:03:43 AM US Eastern Daylight Time	08/04/2022 09:33:19 AM Eastern Daylight Time	07/31/2022 01:29:06 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS Orlando (HMO)	01	01		1			H1290	018	0	2023	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	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 07:06:03 AM US Eastern Daylight Time	08/04/2022 09:33:46 AM Eastern Daylight Time	07/31/2022 01:29:28 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Miami-Dade (HMO D-SNP)	01	01		1			H1290	019	0	2023	Miami-Dade County		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	9	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 08:04:16 AM US Eastern Daylight Time	08/04/2022 09:34:13 AM Eastern Daylight Time	07/31/2022 01:29:50 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Broward (HMO D-SNP)	01	01		1			H1290	020	0	2023	Broward County		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	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 07:15:35 AM US Eastern Daylight Time	08/04/2022 09:34:39 AM Eastern Daylight Time	07/31/2022 01:30:12 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Palm Beach (HMO D-SNP)	01	01		1			H1290	021	0	2023	Palm Beach County		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	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 07:19:50 AM US Eastern Daylight Time	08/04/2022 09:35:04 AM Eastern Daylight Time	07/31/2022 01:30:33 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Orlando (HMO D-SNP)	01	01		1			H1290	022	0	2023	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	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 07:23:59 AM US Eastern Daylight Time	08/04/2022 09:35:30 AM Eastern Daylight Time	07/31/2022 01:30:54 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Jacksonville (HMO D-SNP)	01	01		1			H1290	023	0	2023	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	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 07:28:34 AM US Eastern Daylight Time	08/04/2022 09:35:56 AM Eastern Daylight Time	07/31/2022 01:31:16 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Tampa (HMO D-SNP)	01	01		1			H1290	024	0	2023	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	08/03/2022	2023.01	08/03/2022 08:04:55 AM US Eastern Daylight Time	08/04/2022 09:36:24 AM Eastern Daylight Time	07/31/2022 01:31:37 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Manatee (HMO)	01	01		1			H1290	025	0	2023	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	08/03/2022	2023.01	08/03/2022 08:05:20 AM US Eastern Daylight Time	08/04/2022 09:36:51 AM Eastern Daylight Time	07/31/2022 01:31:59 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE North Florida (HMO)	01	01		1			H1290	027	0	2023	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	08/03/2022	2023.01	08/03/2022 08:05:45 AM US Eastern Daylight Time	08/04/2022 09:37:17 AM Eastern Daylight Time	07/31/2022 01:32:20 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Jacksonville (HMO)	01	01		1			H1290	029	0	2023	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	08/03/2022	2023.01	08/03/2022 08:06:13 AM US Eastern Daylight Time	08/04/2022 09:37:45 AM Eastern Daylight Time	07/31/2022 01:32:42 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS Jacksonville (HMO)	01	01		1			H1290	031	0	2023	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	11	1			1		1	08/03/2022	2023.01	08/03/2022 08:06:45 AM US Eastern Daylight Time	08/04/2022 09:38:10 AM Eastern Daylight Time	07/31/2022 01:33:03 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS Manatee (HMO)	01	01		1			H1290	032	0	2023	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	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 08:00:34 AM US Eastern Daylight Time	08/04/2022 09:38:36 AM Eastern Daylight Time	07/31/2022 01:33:25 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL North Florida (HMO D-SNP)	01	01		1			H1290	033	0	2023	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	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 08:08:55 AM US Eastern Daylight Time	08/04/2022 09:39:02 AM Eastern Daylight Time	07/31/2022 01:33:46 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Manatee (HMO D-SNP)	01	01		1			H1290	034	0	2023	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	11	1			1		1	08/03/2022	2023.01	08/03/2022 08:07:15 AM US Eastern Daylight Time	08/04/2022 09:39:28 AM Eastern Daylight Time	07/31/2022 01:34:08 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS North Florida (HMO)	01	01		1			H1290	035	0	2023	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	10	1			1		1	08/03/2022	2023.01	08/03/2022 08:07:44 AM US Eastern Daylight Time	08/04/2022 09:39:58 AM Eastern Daylight Time	07/31/2022 01:34:29 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Tampa (HMO)	01	01		1			H1290	036	1	2023	Greater Tampa Bay	Hillsborough, 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	12	1			1		1	09/10/2022	2023.01	09/10/2022 12:25:21 AM US Eastern Daylight Time	08/04/2022 09:40:28 AM Eastern Daylight Time	07/31/2022 01:34:51 PM Eastern Daylight Time			09/27/2022 10:27:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Tampa (HMO)	01	01		1			H1290	036	2	2023	Greater Tampa Bay	Polk, Pinellas	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	07/21/2022	2023.01	07/21/2022 08:23:27 AM US Eastern Daylight Time	08/04/2022 09:40:54 AM Eastern Daylight Time	07/31/2022 01:35:12 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted PRIME (HMO)	01	01		1			H1290	037	1	2023	South & Central Florida	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	10	1			1		1	07/21/2022	2023.01	07/21/2022 08:28:08 AM US Eastern Daylight Time	08/04/2022 09:41:19 AM Eastern Daylight Time	07/31/2022 01:35:34 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted PRIME (HMO)	01	01		1			H1290	037	2	2023	South & Central Florida	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	10	1			1		1	07/21/2022	2023.01	07/21/2022 08:31:52 AM US Eastern Daylight Time	08/04/2022 09:41:49 AM Eastern Daylight Time	07/31/2022 01:35:55 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted PRIME (HMO)	01	01		1			H1290	037	3	2023	South & Central Florida	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	037	4	1	01	01	H1290_037_4	10	1			1		1	07/21/2022	2023.01	07/21/2022 08:35:43 AM US Eastern Daylight Time	08/04/2022 09:42:19 AM Eastern Daylight Time	07/31/2022 01:36:17 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted PRIME (HMO)	01	01		1			H1290	037	4	2023	South & Central Florida	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	037	5	1	01	01	H1290_037_5	10	1			1		1	07/21/2022	2023.01	07/21/2022 08:39:44 AM US Eastern Daylight Time	08/04/2022 09:42:47 AM Eastern Daylight Time	07/31/2022 01:36:38 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted PRIME (HMO)	01	01		1			H1290	037	5	2023	South & Central Florida	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			
H1290	039	0	1	01	01	H1290_039_0	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 08:58:02 AM US Eastern Daylight Time	08/04/2022 09:35:24 AM Eastern Daylight Time	07/31/2022 01:37:00 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL East Coast Florida (HMO D-SNP)	01	01		1			H1290	039	0	2023	Brevard, Indian River, Martin, St. Lucie 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	041	0	1	01	01	H1290_041_0	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 08:57:41 AM US Eastern Daylight Time	08/04/2022 09:35:47 AM Eastern Daylight Time	07/31/2022 01:37:21 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Daytona (HMO D-SNP)	01	01		1			H1290	041	0	2023	Flagler and Volusia 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	042	0	1	01	01	H1290_042_0	10	1	2	1	1		0	07/22/2022	2023.01	07/22/2022 11:02:00 AM US Eastern Daylight Time	08/04/2022 09:36:11 AM Eastern Daylight Time	07/31/2022 01:37:43 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Northwest Florida - 1 (HMO D-SNP)	01	01		1			H1290	042	0	2023	Escambia, Santa Rosa Counties		2		2			1	3		1					1	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	043	0	1	01	01	H1290_043_0	10	1	2	1	1		0	07/22/2022	2023.01	07/22/2022 11:02:10 AM US Eastern Daylight Time	08/04/2022 09:36:36 AM Eastern Daylight Time	07/31/2022 01:38:04 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Northwest Florida - 2 (HMO D-SNP)	01	01		1			H1290	043	0	2023	Escambia, Santa Rosa 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	044	1	1	01	01	H1290_044_1	13	1			1		1	09/10/2022	2023.01	09/10/2022 12:30:45 AM US Eastern Daylight Time	08/04/2022 09:43:16 AM Eastern Daylight Time	07/31/2022 01:38:26 PM Eastern Daylight Time			09/27/2022 10:27:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted PREMIUM (HMO)	01	01		1			H1290	044	1	2023	Clay, Duval, Nassau, Lake, Marion, Sumter, Manatee	Lake, Marion, & 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	044	2	1	01	01	H1290_044_2	13	1			1		1	09/10/2022	2023.01	09/10/2022 12:39:21 AM US Eastern Daylight Time	08/04/2022 09:43:42 AM Eastern Daylight Time	07/31/2022 01:38:47 PM Eastern Daylight Time			09/27/2022 10:27:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted PREMIUM (HMO)	01	01		1			H1290	044	2	2023	Clay, Duval, Nassau, Lake, Marion, Sumter, Manatee	Clay, Duval, & 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	044	3	1	01	01	H1290_044_3	13	1			1		1	09/10/2022	2023.01	09/10/2022 12:43:11 AM US Eastern Daylight Time	08/04/2022 09:44:07 AM Eastern Daylight Time	07/31/2022 01:39:09 PM Eastern Daylight Time			09/27/2022 10:27:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted PREMIUM (HMO)	01	01		1			H1290	044	3	2023	Clay, Duval, Nassau, Lake, Marion, Sumter, Manatee	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	2			
H1290	045	0	1	01	01	H1290_045_0	11	1			1		1	08/03/2022	2023.01	08/03/2022 03:01:18 PM US Eastern Daylight Time	08/04/2022 09:37:01 AM Eastern Daylight Time	07/31/2022 01:39:31 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS East Coast Florida (HMO)	01	01		1			H1290	045	0	2023	Brevard, Indian River, Martin, St. Lucie 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	046	0	1	01	01	H1290_046_0	10	1			1		1	08/03/2022	2023.01	08/03/2022 08:10:35 AM US Eastern Daylight Time	08/04/2022 09:37:24 AM Eastern Daylight Time	07/31/2022 01:39:52 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE East Coast Florida (HMO)	01	01		1			H1290	046	0	2023	Brevard, Indian River, Martin, St. Lucie 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	049	0	1	01	01	H1290_049_0	11	1			1		1	08/03/2022	2023.01	08/03/2022 08:11:07 AM US Eastern Daylight Time	08/04/2022 09:37:53 AM Eastern Daylight Time	07/31/2022 01:40:14 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS Daytona (HMO)	01	01		1			H1290	049	0	2023	Flagler and Volusia 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	050	0	1	01	01	H1290_050_0	10	1			1		1	08/03/2022	2023.01	08/03/2022 08:11:32 AM US Eastern Daylight Time	08/04/2022 09:38:17 AM Eastern Daylight Time	07/31/2022 01:40:36 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Daytona (HMO)	01	01		1			H1290	050	0	2023	Flagler and Volusia 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	051	1	1	01	01	H1290_051_1	11	1			1		1	08/03/2022	2023.01	08/03/2022 08:12:14 AM US Eastern Daylight Time	08/04/2022 09:44:38 AM Eastern Daylight Time	07/31/2022 01:40:58 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS Tampa (HMO)	01	01		1			H1290	051	1	2023	Greater Tampa Bay	Hernando, Hillsborough, 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	2			
H1290	051	2	1	01	01	H1290_051_2	11	1			1		1	08/03/2022	2023.01	08/03/2022 08:12:30 AM US Eastern Daylight Time	08/04/2022 09:45:04 AM Eastern Daylight Time	07/31/2022 01:41:19 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted ESSENTIALS Tampa (HMO)	01	01		1			H1290	051	2	2023	Greater Tampa Bay	Pinellas and Polk 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			
H1302	004	0	1	04	01	H1302_004_0	2	1				0	0	07/12/2022	2023.01	07/12/2022 10:45:44 AM Mountain Daylight Time	06/03/2022 10:33:26 AM Mountain Daylight Time				07/14/2022 11:00:32 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	2023	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	04/19/2022	2023.01	04/19/2022 04:30:38 PM Mountain Daylight Time					06/03/2022 11:20:35 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	2023	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						04/20/2022	2023.01	04/20/2022 09:17:39 AM Mountain Daylight Time					06/03/2022 11:20:35 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	2023	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						04/20/2022	2023.01	04/20/2022 09:20:38 AM Mountain Daylight Time					06/03/2022 11:20:35 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	2023	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	6	1				0	0	07/06/2022	2023.01	07/06/2022 12:55:37 PM Pacific Daylight Time	06/01/2022 05:12:08 PM Pacific Daylight Time				07/11/2022 09:05:44 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence Valiance (PPO)	01	04		1			H1304	001	0	2023	Select Counties in Idaho/Asotin Co, WA		2		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)-		(800)735-2900		(711)-										2					2						2			
H1304	004	0	1	04	01	H1304_004_0	8	1					1	07/06/2022	2023.01	07/06/2022 12:56:43 PM Pacific Daylight Time	08/04/2022 02:25:34 PM Pacific Daylight Time	08/01/2022 01:30:00 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Idaho/Asotin Co, WA		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H1304	011	1	1	04	01	H1304_011_1	9	1					1	08/04/2022	2023.01	08/04/2022 12:19:54 PM Pacific Daylight Time	08/04/2022 02:26:14 PM Pacific Daylight Time	08/01/2022 01:31:22 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Idaho/Asotin Co, WA	South	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H1304	011	2	1	04	01	H1304_011_2	9	1					1	08/04/2022	2023.01	08/04/2022 11:08:45 AM Pacific Daylight Time	08/04/2022 02:26:52 PM Pacific Daylight Time	08/01/2022 01:32:46 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Idaho/Asotin Co, WA	North	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H1304	012	1	1	04	01	H1304_012_1	8	1					1	08/04/2022	2023.01	08/04/2022 11:15:42 AM Pacific Daylight Time	08/04/2022 02:27:31 PM Pacific Daylight Time	08/01/2022 01:34:06 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Idaho/Asotin Co, WA	South	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H1304	012	2	1	04	01	H1304_012_2	8	1					1	08/04/2022	2023.01	08/04/2022 11:22:17 AM Pacific Daylight Time	08/04/2022 02:28:09 PM Pacific Daylight Time	08/01/2022 01:35:25 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Idaho/Asotin Co, WA	North	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H1304	803	0	1	04	01	H1304_803_0	1	1				0	0	05/17/2022	2023.01	05/17/2022 01:55:51 PM Pacific Daylight Time					05/17/2022 02:26:52 PM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H1304	803	0	2023	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	1	1						05/11/2022	2023.01	05/11/2022 09:39:59 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	Nationwide except territories		1	7704	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	1	1						05/06/2022	2023.01	05/06/2022 09:50:49 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	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	1	1						05/06/2022	2023.01	05/06/2022 09:50:55 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	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						06/06/2022	2023.01	06/06/2022 04:09:40 PM Eastern Daylight Time		06/06/2022 04:08:38 PM Eastern Daylight Time			06/06/2022 04:10:25 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	2023	Greater Kalamazoo and Calhoun County Areas		2		2			2									seniorcarepartnersmi.org	seniorcarepartnersmi.org												(269)441-9300				(269)441-9300												(269)280-9584				(269)280-9584																
H1310	003	0	1	20	08	H1310_003_0	1	1						06/06/2022	2023.01	06/06/2022 04:09:51 PM Eastern Daylight Time		06/06/2022 04:08:38 PM Eastern Daylight Time			06/06/2022 04:10:25 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	2023	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																
H1347	001	0	1	04	01	H1347_001_0	3	1					1	08/04/2022	2023.01	08/04/2022 03:47:40 PM Central Daylight Time	08/05/2022 10:44:18 AM Central Daylight Time	08/05/2022 10:44:27 AM Central Daylight Time			08/05/2022 10:52:58 AM Central Daylight Time	PATRIUS HEALTH INC	Patrius Health	www.patriushealth.com	Blue Advantage Plus (PPO)	01	04		1			H1347	001	0	2023	State of Mississippi		2		2			2									www.patriushealth.com	www.patriushealth.com	www.patriushealth.com	(888)950-0705		(888)950-0705		(855)457-5987		(855)457-5987		(888)950-0705		(888)950-0705		(855)457-5987		(855)457-5987		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1350	006	0	1	01	01	H1350_006_0	3	1				0	0	07/12/2022	2023.01	07/12/2022 10:47:35 AM Mountain Daylight Time	07/19/2022 10:24:48 AM Mountain Daylight Time				07/19/2022 10:37:23 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	2023	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	08/03/2022	2023.01	08/03/2022 04:47:33 PM Mountain Daylight Time	08/05/2022 02:43:47 PM Mountain Daylight Time	08/05/2022 02:43:48 PM Mountain Daylight Time			08/05/2022 02:56:51 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	bcidaho.com/idahotruebluesnp	True Blue Special Needs Plan (HMO D-SNP)	01	01		1			H1350	009	0	2023	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	023	1	1	01	01	H1350_023_1	4	1						07/12/2022	2023.01	07/12/2022 10:50:32 AM Mountain Daylight Time	08/05/2022 02:43:48 PM Mountain Daylight Time	08/05/2022 02:43:48 PM Mountain Daylight Time			08/05/2022 02:56:51 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	2023	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						07/12/2022	2023.01	07/12/2022 10:52:10 AM Mountain Daylight Time	08/05/2022 02:43:48 PM Mountain Daylight Time	08/05/2022 02:43:49 PM Mountain Daylight Time			08/05/2022 02:56:51 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	2023	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	4	1						08/03/2022	2023.01	08/03/2022 04:49:03 PM Mountain Daylight Time	08/05/2022 02:43:49 PM Mountain Daylight Time	08/05/2022 02:43:49 PM Mountain Daylight Time			08/05/2022 02:56:51 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	2023	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						08/03/2022	2023.01	08/03/2022 04:49:29 PM Mountain Daylight Time	08/05/2022 02:43:49 PM Mountain Daylight Time	08/05/2022 02:43:49 PM Mountain Daylight Time			08/05/2022 02:56:51 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	2023	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	4	1						08/03/2022	2023.01	08/03/2022 04:50:00 PM Mountain Daylight Time	08/05/2022 02:43:50 PM Mountain Daylight Time	08/05/2022 02:43:50 PM Mountain Daylight Time			08/05/2022 02:56:51 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	2023	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	08/03/2022	2023.01	08/03/2022 04:51:21 PM Mountain Daylight Time	08/05/2022 02:43:50 PM Mountain Daylight Time	08/05/2022 02:43:50 PM Mountain Daylight Time			08/05/2022 02:56:51 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	bcidaho.com/idahotruebluesnp	True Blue Special Needs Plan (HMO D-SNP)	01	01		1			H1350	025	0	2023	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						08/03/2022	2023.01	08/03/2022 04:53:15 PM Mountain Daylight Time	08/05/2022 02:43:50 PM Mountain Daylight Time	08/05/2022 02:43:50 PM Mountain Daylight Time			08/05/2022 02:56:51 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	2023	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						08/03/2022	2023.01	08/03/2022 04:53:52 PM Mountain Daylight Time	08/05/2022 02:43:51 PM Mountain Daylight Time	08/05/2022 02:43:51 PM Mountain Daylight Time			08/05/2022 02:56:51 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	2023	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	3	1						08/03/2022	2023.01	08/03/2022 04:54:23 PM Mountain Daylight Time	08/05/2022 02:43:51 PM Mountain Daylight Time	08/05/2022 02:43:51 PM Mountain Daylight Time			08/05/2022 02:56:51 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	2023	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	028	0	1	01	01	H1350_028_0	4	1						08/03/2022	2023.01	08/03/2022 04:55:07 PM Mountain Daylight Time	08/05/2022 02:43:51 PM Mountain Daylight Time	08/05/2022 02:43:51 PM Mountain Daylight Time			08/05/2022 02:56:51 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	028	0	2023	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	029	0	1	01	01	H1350_029_0	4	1						08/05/2022	2023.01	08/05/2022 02:39:06 PM Mountain Daylight Time	08/05/2022 02:43:52 PM Mountain Daylight Time	08/05/2022 02:43:52 PM Mountain Daylight Time			08/05/2022 02:56:51 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	029	0	2023	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	030	0	1	01	01	H1350_030_0	4	1						08/03/2022	2023.01	08/03/2022 05:07:53 PM Mountain Daylight Time	08/05/2022 02:43:52 PM Mountain Daylight Time	08/05/2022 02:43:52 PM Mountain Daylight Time			08/05/2022 02:56:51 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	030	0	2023	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	803	0	1	01	01	H1350_803_0	1	1				0	0	04/20/2022	2023.01	04/20/2022 09:37:05 AM Mountain Daylight Time					06/03/2022 11:20:35 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	2023	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						04/20/2022	2023.01	04/20/2022 09:40:43 AM Mountain Daylight Time					06/03/2022 11:20:35 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	2023	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						04/20/2022	2023.01	04/20/2022 10:11:31 AM Mountain Daylight Time					06/03/2022 11:20:35 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	2023	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						04/20/2022	2023.01	04/20/2022 10:21:24 AM Mountain Daylight Time					06/03/2022 11:20:35 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	2023	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						04/20/2022	2023.01	04/20/2022 10:34:37 AM Mountain Daylight Time					06/03/2022 11:20:35 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	2023	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	6	1					1	08/03/2022	2023.01	08/03/2022 08:14:04 AM Eastern Daylight Time	08/04/2022 05:50:55 PM Eastern Daylight Time	08/04/2022 05:50:53 PM Eastern Daylight Time			08/04/2022 06:15:53 PM Eastern Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue KC Spira Care (HMO)	01	01		1			H1352	003	0	2023	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	6	1					1	08/03/2022	2023.01	08/03/2022 08:23:29 AM Eastern Daylight Time	08/04/2022 05:50:54 PM Eastern Daylight Time	08/04/2022 05:50:54 PM Eastern Daylight Time			08/04/2022 06:15:53 PM Eastern Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue KC Secure (HMO)	01	01		1			H1352	004	0	2023	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	2	1				0	0	05/31/2022	2023.01	05/31/2022 12:50:54 PM Eastern Daylight Time					05/31/2022 01:03:54 PM Eastern 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	2023	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	2	1						05/31/2022	2023.01	05/31/2022 12:51:05 PM Eastern Daylight Time					05/31/2022 01:03:54 PM Eastern 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	2023	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	2	1						05/31/2022	2023.01	05/31/2022 12:51:27 PM Eastern Daylight Time					05/31/2022 01:03:54 PM Eastern 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	2023	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	2	1						05/31/2022	2023.01	05/31/2022 12:51:36 PM Eastern Daylight Time					05/31/2022 01:03:54 PM Eastern 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	2023	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	5	1	2	1	1		0	07/14/2022	2023.01	07/14/2022 02:42:17 PM Eastern Daylight Time	08/03/2022 08:00:15 PM Eastern Daylight Time	07/30/2022 08:13:00 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in WA		2		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	5	1	2	1	1		0	07/14/2022	2023.01	07/14/2022 02:43:21 PM Eastern Daylight Time	08/03/2022 08:11:33 PM Eastern Daylight Time	07/30/2022 08:13:32 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in WA		2		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						08/02/2022	2023.01	08/02/2022 10:17:38 AM Eastern Daylight Time	08/03/2022 08:13:26 PM Eastern Daylight Time	07/30/2022 08:14:04 AM Eastern Daylight Time			08/04/2022 05:06:33 PM Eastern Daylight Time	WELLCARE OF WASHINGTON, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1353	005	0	2023	Select counties in WA		2		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						08/03/2022	2023.01	08/03/2022 03:14:02 PM Eastern Daylight Time	08/03/2022 08:14:56 PM Eastern Daylight Time	07/30/2022 08:14:35 AM Eastern Daylight Time			08/04/2022 05:06:33 PM Eastern Daylight Time	WELLCARE OF WASHINGTON, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1353	006	0	2023	Select counties in WA		2		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						05/26/2022	2023.01	05/26/2022 11:53:31 AM Eastern Daylight Time	08/03/2022 08:16:23 PM Eastern Daylight Time	07/30/2022 08:15:07 AM Eastern Daylight Time			08/04/2022 05:06:33 PM Eastern Daylight Time	WELLCARE OF WASHINGTON, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H1353	007	0	2023	Select counties in WA		2		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	1	1						05/30/2022	2023.01	05/30/2022 10:31:48 AM Eastern Daylight Time		05/24/2022 07:52:32 PM Eastern Daylight Time			05/30/2022 10:34:33 AM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	08	20		1			H1357	001	0	2023	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	1	1						05/30/2022	2023.01	05/30/2022 10:31:05 AM Eastern Daylight Time		05/24/2022 07:54:30 PM Eastern Daylight Time			05/30/2022 10:34:33 AM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	08	20		1			H1357	002	0	2023	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	02	01	H1360_001_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 01:29:40 PM Central Daylight Time	08/03/2022 11:00:41 AM Central Daylight Time	07/31/2022 12:46:29 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H1360	001	0	2023	Clark and Washoe Counties		2		2			1	3		1					1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1365	001	0	1	04	01	H1365_001_0	6	1					1	08/03/2022	2023.01	08/03/2022 05:06:32 PM Eastern Daylight Time	08/05/2022 09:12:08 AM Eastern Daylight Time	08/05/2022 09:12:20 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	Southern Maine & Southern New Hampshire		2		2			2									MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	004	1	1	04	01	H1365_004_1	5	1					1	08/03/2022	2023.01	08/03/2022 02:00:48 PM Eastern Daylight Time	08/05/2022 09:12:32 AM Eastern Daylight Time	08/05/2022 09:12:45 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	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)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	004	2	1	04	01	H1365_004_2	5	1					1	08/03/2022	2023.01	08/03/2022 03:40:41 PM Eastern Daylight Time	08/05/2022 09:12:58 AM Eastern Daylight Time	08/05/2022 09:13:10 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	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)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	802	0	1	04	01	H1365_802_0	3	1						05/17/2022	2023.01	05/17/2022 02:37:25 PM Eastern Daylight Time					06/03/2022 01:46:33 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	2023	National		1	0	2			2									MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	803	0	1	04	01	H1365_803_0	3	1						05/17/2022	2023.01	05/17/2022 02:40:03 PM Eastern Daylight Time					06/03/2022 01:46:33 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	2023	National		1	0	2			2									MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1372	001	0	1	01	01	H1372_001_0	8	1		1	1		0	08/02/2022	2023.01	08/02/2022 07:53:56 PM Central Daylight Time	08/03/2022 11:32:58 AM Central Daylight Time	08/02/2022 10:57:20 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	MARQUIS ADVANTAGE, INC.	AgeRight Advantage	www.agerightadvantage.com	AgeRight Advantage Health Plan (HMO I-SNP)	01	01		1			H1372	001	0	2023	Oregon (partial)		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	8	1		1	2		1	08/02/2022	2023.01	08/02/2022 07:55:25 PM Central Daylight Time	08/03/2022 11:33:32 AM Central Daylight Time	08/10/2022 02:34:41 PM Central Daylight Time			08/11/2022 01:06:56 PM Central Daylight Time	MARQUIS ADVANTAGE, INC.	AgeRight Advantage	www.agerightadvantage.com	AgeRight Advantage Plus Health Plan (HMO I-SNP)	01	01		1			H1372	002	0	2023	Oregon (partial)		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	9	1		1	2		1	08/02/2022	2023.01	08/02/2022 07:56:11 PM Central Daylight Time	08/03/2022 05:09:37 PM Central Daylight Time	08/10/2022 02:29:50 PM Central Daylight Time			08/11/2022 01:06:56 PM Central Daylight Time	MARQUIS ADVANTAGE, INC.	AgeRight Advantage	www.agerightadvantage.com	AgeRight Advantage Premier Health Plan (HMO C-SNP)	01	01		1			H1372	003	0	2023	Oregon (partial)		2		2			1	4			00000000000000000010000					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	02	01	H1375_001_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:45:41 AM Central Daylight Time	08/03/2022 10:24:33 AM Central Daylight Time	07/31/2022 12:46:54 AM Central Daylight Time			08/04/2022 03:52:49 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H1375	001	0	2023	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	02	01	H1375_002_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 08:22:31 AM Central Daylight Time	08/03/2022 10:25:13 AM Central Daylight Time	07/31/2022 12:47:18 AM Central Daylight Time			08/04/2022 03:52:49 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H1375	002	0	2023	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	1		0	08/01/2022	2023.01	08/01/2022 12:54:52 PM Eastern Daylight Time	08/03/2022 07:57:35 PM Eastern Daylight Time	07/30/2022 08:15:39 AM Eastern Daylight Time			08/04/2022 06:10:56 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcareNE.com	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H1395	001	0	2023	Select counties in NE		2		2			1	3		1					1	www.wellcareNE.com	www.wellcareNE.com	www.wellcareNE.com	(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	4	1						08/01/2022	2023.01	08/01/2022 12:53:43 PM Eastern Daylight Time	08/03/2022 07:58:49 PM Eastern Daylight Time	07/30/2022 08:16:11 AM Eastern Daylight Time			08/04/2022 06:10:56 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcareNE.com	Wellcare No Premium Open (PPO)	01	04		1			H1395	002	0	2023	Select counties in NE		2		2			2									www.wellcareNE.com	www.wellcareNE.com	www.wellcareNE.com	(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	4	1						05/29/2022	2023.01	05/29/2022 05:51:36 PM Eastern Daylight Time	08/03/2022 08:00:03 PM Eastern Daylight Time	07/30/2022 08:16:44 AM Eastern Daylight Time			08/04/2022 06:10:56 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcareNE.com	Wellcare Assist Open (PPO)	01	04		1			H1395	003	0	2023	Select counties in NE		2		2			2									www.wellcareNE.com	www.wellcareNE.com	www.wellcareNE.com	(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	4	1				0	0	06/01/2022	2023.01	06/01/2022 07:08:13 PM Central Daylight Time	07/12/2022 10:43:39 AM Central Daylight Time				07/15/2022 10:11:09 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H1415	013	0	2023	Chicago		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1415	021	0	1	02	01	H1415_021_0	5	1						08/02/2022	2023.01	08/02/2022 05:59:37 PM Central Daylight Time	08/03/2022 04:58:31 PM Central Daylight Time	08/01/2022 10:26:33 AM Central Daylight Time			08/04/2022 04:14:31 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Premier Medicare (HMO-POS)	01	02		1			H1415	021	0	2023	Chicago		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1415	024	0	1	01	01	H1415_024_0	5	1					1	08/03/2022	2023.01	08/03/2022 04:16:36 PM Central Daylight Time	08/03/2022 04:59:57 PM Central Daylight Time	08/01/2022 10:27:04 AM Central Daylight Time			08/04/2022 04:14:31 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H1415	024	0	2023	Chicago		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	009	0	1	02	01	H1416_009_0	4	1			2			08/01/2022	2023.01	08/01/2022 12:29:12 PM Eastern Daylight Time	08/03/2022 07:57:11 PM Eastern Daylight Time	07/30/2022 08:17:16 AM Eastern Daylight Time			08/04/2022 06:08:31 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H1416	009	0	2023	Select counties in IL		2		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			2			05/27/2022	2023.01	05/27/2022 07:51:07 PM Eastern Daylight Time	08/03/2022 07:58:17 PM Eastern Daylight Time	07/30/2022 08:17:47 AM Eastern Daylight Time			08/04/2022 06:08:31 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Compass (HMO)	01	01		1			H1416	023	0	2023	Select counties in IL		2		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						08/03/2022	2023.01	08/03/2022 03:42:30 PM Eastern Daylight Time	08/03/2022 08:24:37 PM Eastern Daylight Time	07/30/2022 08:18:18 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium (HMO-POS)	01	02		1			H1416	026	0	2023	Select counties in MS		2		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	6	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 11:48:17 AM Eastern Daylight Time	08/03/2022 08:25:50 PM Eastern Daylight Time	07/30/2022 08:18:50 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		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	6	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 12:56:35 PM Eastern Daylight Time	08/03/2022 08:27:05 PM Eastern Daylight Time	07/30/2022 08:19:26 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in MS		2		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	1		0	08/01/2022	2023.01	08/01/2022 12:13:57 PM Eastern Daylight Time	08/03/2022 09:30:00 PM Eastern Daylight Time	07/30/2022 08:20:00 AM Eastern Daylight Time			08/04/2022 05:23:51 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	2023	All counties in TN		2		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	7	1	2	1	1		0	07/19/2022	2023.01	07/19/2022 09:01:58 AM Eastern Daylight Time	08/03/2022 07:52:08 PM Central Daylight Time	07/30/2022 07:20:33 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1416	036	0	2023	Select counties in SC		2		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						06/01/2022	2023.01	06/01/2022 05:13:36 PM Eastern Daylight Time	08/03/2022 08:28:17 PM Eastern Daylight Time	07/30/2022 08:21:05 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Compass (HMO)	01	01		1			H1416	041	0	2023	Select counties in AR		2		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	4	1						07/14/2022	2023.01	07/14/2022 08:37:46 AM Eastern Daylight Time	08/03/2022 08:52:49 PM Eastern Daylight Time	07/30/2022 08:21:36 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H1416	042	0	2023	All counties in TN		2		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	6	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 11:49:40 AM Eastern Daylight Time	08/03/2022 08:29:31 PM Eastern Daylight Time	07/30/2022 08:22:08 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		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	6	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 12:57:57 PM Eastern Daylight Time	08/03/2022 08:30:46 PM Eastern Daylight Time	07/30/2022 08:22:40 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in MS		2		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	055	0	1	01	01	H1416_055_0	5	1						08/01/2022	2023.01	08/01/2022 11:51:47 AM Eastern Daylight Time	08/03/2022 08:31:59 PM Eastern Daylight Time	07/30/2022 08:23:13 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Preferred (HMO)	01	01		1			H1416	055	0	2023	Select counties in AR		2		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						08/03/2022	2023.01	08/03/2022 03:16:17 PM Eastern Daylight Time	08/03/2022 07:53:38 PM Central Daylight Time	07/30/2022 07:23:44 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Value (HMO)	01	01		1			H1416	056	0	2023	Select counties in SC		2		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						08/03/2022	2023.01	08/03/2022 03:17:14 PM Eastern Daylight Time	08/03/2022 07:55:11 PM Central Daylight Time	07/30/2022 07:24:16 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Value (HMO)	01	01		1			H1416	057	0	2023	Select counties in SC		2		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	4	1				0	0	05/25/2022	2023.01	05/25/2022 09:37:31 PM Eastern Daylight Time	06/03/2022 06:58:24 PM Eastern Daylight Time				07/15/2022 04:34:34 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback (HMO-POS)	01	02		1			H1416	058	0	2023	Select counties in AR		2		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	3	1				0	0	05/26/2022	2023.01	05/26/2022 11:41:02 AM Eastern Daylight Time	06/03/2022 05:55:41 PM Central Daylight Time				07/15/2022 03:18:19 PM Central Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO-POS)	01	02		1			H1416	059	0	2023	Select counties in SC		2		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	4	1				0	0	05/25/2022	2023.01	05/25/2022 09:39:27 PM Eastern Daylight Time	06/03/2022 06:59:39 PM Eastern Daylight Time				07/15/2022 04:34:34 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback (HMO-POS)	01	02		1			H1416	060	0	2023	Select counties in MS		2		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	3	1				0	0	05/25/2022	2023.01	05/25/2022 04:33:20 PM Eastern Daylight Time	06/03/2022 06:38:09 PM Eastern Daylight Time				07/15/2022 04:36:04 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback (HMO-POS)	01	02		1			H1416	061	0	2023	All counties in TN		2		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						08/01/2022	2023.01	08/01/2022 11:53:19 AM Eastern Daylight Time	08/03/2022 08:33:12 PM Eastern Daylight Time	07/30/2022 08:24:47 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Dividend (HMO)	01	01		1			H1416	064	0	2023	Select counties in AR		2		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						08/03/2022	2023.01	08/03/2022 03:44:05 PM Eastern Daylight Time	08/03/2022 08:34:31 PM Eastern Daylight Time	07/30/2022 08:25:19 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1416	065	0	2023	Select counties in MS		2		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	068	0	1	01	01	H1416_068_0	5	1						05/25/2022	2023.01	05/25/2022 09:44:20 PM Eastern Daylight Time	08/03/2022 08:35:44 PM Eastern Daylight Time	07/30/2022 08:25:51 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H1416	068	0	2023	Select counties in MS		2		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						08/01/2022	2023.01	08/01/2022 12:51:35 PM Eastern Daylight Time	08/03/2022 09:16:39 PM Eastern Daylight Time	07/30/2022 08:26:22 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1416	070	0	2023	Select Counties in MS		2		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						08/03/2022	2023.01	08/03/2022 03:45:00 PM Eastern Daylight Time	08/03/2022 09:17:52 PM Eastern Daylight Time	07/30/2022 08:26:53 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1416	071	0	2023	Select Counties in MS		2		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						08/01/2022	2023.01	08/01/2022 12:55:33 PM Eastern Daylight Time	08/03/2022 09:19:05 PM Eastern Daylight Time	07/30/2022 08:27:25 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1416	072	0	2023	Select Counties in MS		2		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	4	1						08/01/2022	2023.01	08/01/2022 12:06:02 PM Eastern Daylight Time	08/03/2022 08:53:56 PM Eastern Daylight Time	07/30/2022 08:27:57 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H1416	075	0	2023	Select counties in TN		2		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	4	1						08/01/2022	2023.01	08/01/2022 12:07:42 PM Eastern Daylight Time	08/03/2022 08:55:04 PM Eastern Daylight Time	07/30/2022 08:28:28 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H1416	076	0	2023	Select counties in TN		2		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	4	1						08/01/2022	2023.01	08/01/2022 12:08:56 PM Eastern Daylight Time	08/03/2022 08:56:12 PM Eastern Daylight Time	07/30/2022 08:29:00 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H1416	077	0	2023	Select counties in TN		2		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	078	0	1	01	01	H1416_078_0	4	1			2			08/03/2022	2023.01	08/03/2022 02:38:35 PM Eastern Daylight Time	08/03/2022 08:57:22 PM Eastern Daylight Time	07/30/2022 08:29:32 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1416	078	0	2023	Select counties in TN		2		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	079	0	1	01	01	H1416_079_0	4	1			2			08/03/2022	2023.01	08/03/2022 02:39:31 PM Eastern Daylight Time	08/03/2022 08:58:31 PM Eastern Daylight Time	07/30/2022 08:30:07 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1416	079	0	2023	Select counties in TN		2		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	080	0	1	01	01	H1416_080_0	4	1			2			08/03/2022	2023.01	08/03/2022 02:41:35 PM Eastern Daylight Time	08/03/2022 08:59:43 PM Eastern Daylight Time	07/30/2022 08:30:39 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1416	080	0	2023	Select counties in TN		2		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	5	1		1			0	08/01/2022	2023.01	08/01/2022 04:47:06 PM Eastern Daylight Time	08/04/2022 06:22:45 PM Eastern Daylight Time	08/04/2022 06:41:27 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	Pima County		2		2			1	4			00000000000100000000000					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	5	1		1			1	08/01/2022	2023.01	08/01/2022 04:48:59 PM Eastern Daylight Time	08/04/2022 06:22:47 PM Eastern Daylight Time	08/04/2022 06:41:30 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	Pima County		2		2			1	4			00000010000000000000000					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	5	1		1			0	08/01/2022	2023.01	08/01/2022 04:53:18 PM Eastern Daylight Time	08/04/2022 06:22:48 PM Eastern Daylight Time	08/04/2022 06:41:33 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	Pima County		2		2			1	4			00000000000000010000000					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	5	1						08/01/2022	2023.01	08/01/2022 04:55:52 PM Eastern Daylight Time	08/04/2022 06:22:50 PM Eastern Daylight Time	08/04/2022 06:41:36 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H1423	004	0	2023	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	5	1						08/01/2022	2023.01	08/01/2022 04:57:21 PM Eastern Daylight Time	08/04/2022 06:22:51 PM Eastern Daylight Time	08/04/2022 06:41:38 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Smart Value Plus (HMO)	01	01		1			H1423	005	0	2023	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	5	1		1			0	08/01/2022	2023.01	08/01/2022 04:57:43 PM Eastern Daylight Time	08/04/2022 06:22:53 PM Eastern Daylight Time	08/04/2022 06:41:41 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	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	5	1		1			0	07/12/2022	2023.01	07/12/2022 10:13:26 AM Eastern Daylight Time	08/04/2022 06:22:54 PM Eastern Daylight Time	08/04/2022 06:41:44 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	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	5	1					0	08/01/2022	2023.01	08/01/2022 05:27:12 PM Eastern Daylight Time	08/04/2022 06:22:55 PM Eastern Daylight Time	08/04/2022 06:41:46 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Plus (HMO)	01	01		1			H1423	009	0	2023	Maricopa and surrounding counties		2		2			2									https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)461-2271		(833)461-2271		(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	6	1					1	09/05/2022	2023.01	09/05/2022 11:06:22 AM Eastern Daylight Time	09/05/2022 05:30:15 PM Eastern Daylight Time	09/05/2022 05:30:15 PM Eastern Daylight Time			09/05/2022 05:32:35 PM Eastern Daylight Time	CCA HEALTH PLANS OF CALIFORNIA, INC.	CCA Health California	https://www.commonwealthcarealliance.org/ca/	CCA Medicare Excel (HMO)	01	01		1			H1426	001	0	2023	Central Valley		2		2			2									www.VitalityHP.net	https://www.commonwealthcarealliance.org/ca/members/covered-drugs/	https://www.commonwealthcarealliance.org/ca/members/find-a-doctor-or-pharmacy/	(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(888)254-9907		(888)254-9907		(866)333-3530		(866)333-3530		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1426	002	0	1	01	01	H1426_002_0	5	1					1	08/10/2022	2023.01	08/10/2022 03:59:52 PM Eastern Daylight Time	08/05/2022 11:07:07 AM Eastern Daylight Time	08/05/2022 11:07:07 AM Eastern Daylight Time			08/10/2022 04:05:37 PM Eastern Daylight Time	VITALITY HEALTH PLAN OF CALIFORNIA, INC.	CCA Health California	https://www.commonwealthcarealliance.org/ca/	CCA Medicare Excel (HMO)	01	01		1			H1426	002	0	2023	Santa Clara County		2		2			2									www.VitalityHP.net	https://www.commonwealthcarealliance.org/ca/members/covered-drugs/	https://www.commonwealthcarealliance.org/ca/members/find-a-doctor-or-pharmacy/	(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(888)254-9907		(888)254-9907		(866)333-3530		(866)333-3530		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	003	0	1	01	01	H1463_003_0	5	1					1	08/04/2022	2023.01	08/04/2022 12:36:54 PM Central Daylight Time	08/05/2022 09:52:54 AM Central Daylight Time	08/05/2022 09:52:57 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	North Central, Central, Southern, & Quad Cities IL		2		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	5	1				0	0	08/04/2022	2023.01	08/04/2022 09:26:00 AM Central Daylight Time	06/03/2022 07:35:09 AM Central Daylight Time				08/05/2022 10:29:56 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO Basic (HMO)	01	01		1			H1463	008	0	2023	North Central, Central, Southern, & Quad Cities IL		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:37:13 PM Central Daylight Time	08/05/2022 09:52:54 AM Central Daylight Time	08/05/2022 09:52:57 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	North Central, Central, Southern, & Quad Cities IL		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:37:31 PM Central Daylight Time	08/05/2022 09:52:55 AM Central Daylight Time	08/05/2022 09:52:57 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	North Central, Central, Southern, & Quad Cities IL		2		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	014	0	1	02	01	H1463_014_0	5	1				0	0	08/04/2022	2023.01	08/04/2022 09:45:02 AM Central Daylight Time	06/03/2022 07:35:19 AM Central Daylight Time				08/05/2022 10:29:56 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare POS Basic (HMO-POS)	01	02		1			H1463	014	0	2023	North Central, Central, Southern, & Quad Cities IL		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:38:01 PM Central Daylight Time	08/05/2022 09:52:55 AM Central Daylight Time	08/05/2022 09:52:57 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	North Central, Central, Southern, & Quad Cities IL		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:38:26 PM Central Daylight Time	08/05/2022 09:52:55 AM Central Daylight Time	08/05/2022 09:52:57 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	North Central, Central, Southern, & Quad Cities IL		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:38:54 PM Central Daylight Time	08/05/2022 09:52:55 AM Central Daylight Time	08/05/2022 09:52:57 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	North Central, Central, Southern, & Quad Cities IL		2		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	5	1				0	0	08/04/2022	2023.01	08/04/2022 09:54:48 AM Central Daylight Time	06/03/2022 07:35:33 AM Central Daylight Time				08/05/2022 10:29:56 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare HMO (HMO)	01	01		1			H1463	020	0	2023	East Central IN and Western OH		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:39:15 PM Central Daylight Time	08/05/2022 09:52:55 AM Central Daylight Time	08/05/2022 09:52:57 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	Whiteside,Henry, Mercer,Rock Island IL & Scott IA		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:39:38 PM Central Daylight Time	08/05/2022 09:52:55 AM Central Daylight Time	08/05/2022 09:52:58 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	East Central IN		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:39:58 PM Central Daylight Time	08/05/2022 09:52:55 AM Central Daylight Time	08/05/2022 09:52:58 AM Central Daylight Time			08/05/2022 10:20:27 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete 1 (HMO)	01	01		1			H1463	023	0	2023	Eastcentral/Northeast IL; Westcentral/Northwest IN		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:40:20 PM Central Daylight Time	08/05/2022 09:52:56 AM Central Daylight Time	08/05/2022 09:52:58 AM Central Daylight Time			08/05/2022 10:20:27 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete 2 (HMO)	01	01		1			H1463	024	0	2023	Eastcentral/Northeast IL; Westcentral/Northwest IN		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:40:40 PM Central Daylight Time	08/05/2022 09:52:56 AM Central Daylight Time	08/05/2022 09:52:58 AM Central Daylight Time			08/05/2022 10:20:27 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete 3 (HMO-POS)	01	02		1			H1463	025	0	2023	Eastcentral/Northeast IL; Westcentral/Northwest IN		2		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	035	0	1	01	01	H1463_035_0	5	1					1	08/04/2022	2023.01	08/04/2022 12:41:10 PM Central Daylight Time	08/05/2022 09:52:56 AM Central Daylight Time	08/05/2022 09:52:58 AM Central Daylight Time			08/05/2022 10:20:27 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Core (HMO)	01	01		1			H1463	035	0	2023	West Central; Northern IL in contracted counties		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:41:39 PM Central Daylight Time	08/05/2022 09:52:56 AM Central Daylight Time	08/05/2022 09:52:58 AM Central Daylight Time			08/05/2022 10:20:27 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Open (HMO-POS)	01	02		1			H1463	036	0	2023	West Central; Northern IL in contracted counties		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:42:01 PM Central Daylight Time	08/05/2022 09:52:56 AM Central Daylight Time	08/05/2022 09:52:58 AM Central Daylight Time			08/05/2022 10:20:27 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete Richland 1 (HMO)	01	01		1			H1463	039	0	2023	Southeastern IL and Southwestern IN in contracted		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:42:29 PM Central Daylight Time	08/05/2022 09:52:56 AM Central Daylight Time	08/05/2022 09:52:58 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	East Central Indiana		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:42:51 PM Central Daylight Time	08/05/2022 09:52:56 AM Central Daylight Time	08/05/2022 09:52:58 AM Central Daylight Time			08/05/2022 10:20:27 AM 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	2023	East Central IN and Western OH		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:43:16 PM Central Daylight Time	08/05/2022 09:52:56 AM Central Daylight Time	08/05/2022 09:52:59 AM Central Daylight Time			08/05/2022 10:20:27 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Enrich (HMO-POS)	01	02		1			H1463	042	0	2023	West Central; Northern IL contracted counties		2		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	043	0	1	01	01	H1463_043_0	5	1					1	08/04/2022	2023.01	08/04/2022 12:43:38 PM Central Daylight Time	08/05/2022 09:52:57 AM Central Daylight Time	08/05/2022 09:52:59 AM Central Daylight Time			08/05/2022 10:20:27 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO Classic Rx (HMO)	01	01		1			H1463	043	0	2023	North Central, Central, Southern, & Quad Cities IL		2		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	801	0	1	01	01	H1463_801_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 09:33:00 AM Central Daylight Time					06/03/2022 08:27:46 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1463	801	0	2023	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;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	3	1						04/27/2022	2023.01	04/27/2022 09:09:15 AM Central Daylight Time					06/03/2022 08:27:46 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H1463	802	0	2023	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;7c;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	1	2;	1					1				
H1463	810	0	1	01	01	H1463_810_0	3	1						04/27/2022	2023.01	04/27/2022 09:09:45 AM Central Daylight Time					06/03/2022 08:27:46 AM Central 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	2023	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;9b;10a;11a;11b;15;	1	2;	1					1				
H1463	811	0	1	02	01	H1463_811_0	3	1				0	0	04/27/2022	2023.01	04/27/2022 09:10:10 AM Central Daylight Time					06/03/2022 08:27:46 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS (HMO-POS)	01	02		1			H1463	811	0	2023	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;5;7b;7c;7i;8a;8b1;8b2;9a1;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				
H1463	812	0	1	02	01	H1463_812_0	3	1						04/27/2022	2023.01	04/27/2022 09:10:35 AM Central Daylight Time					06/03/2022 08:27:46 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	01	02		1			H1463	812	0	2023	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;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				
H1463	813	0	1	02	01	H1463_813_0	3	1						04/27/2022	2023.01	04/27/2022 09:10:55 AM Central Daylight Time					06/03/2022 08:27:46 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	01	02		1			H1463	813	0	2023	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;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				
H1468	007	0	1	01	01	H1468_007_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:00:52 PM Eastern Daylight Time	08/03/2022 03:43:56 PM Eastern Daylight Time	07/30/2022 06:13:22 AM Eastern Daylight Time			08/04/2022 11:23:43 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1468-007 (HMO)	01	01		1			H1468	007	0	2023	Peoria and Rockford Illinois Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 11:42:25 AM Eastern Daylight Time	08/03/2022 03:46:07 PM Eastern Daylight Time	07/30/2022 06:13:46 AM Eastern Daylight Time			08/04/2022 11:23:43 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1468-013 (HMO)	01	01		1			H1468	013	0	2023	Cook, DuPage, Kankakee, Lake, and Will counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/29/2022	2023.01	05/29/2022 03:08:20 PM Eastern Daylight Time	08/03/2022 03:49:28 PM Eastern Daylight Time	07/30/2022 06:14:12 AM Eastern Daylight Time			08/04/2022 11:23:43 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1468-014 (HMO)	01	01		1			H1468	014	0	2023	Kane, Kendall and McHenry counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 04:02:02 PM Eastern Daylight Time	08/03/2022 03:55:19 PM Eastern Daylight Time	07/30/2022 06:14:36 AM Eastern Daylight Time			08/04/2022 11:23:43 AM 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	2023	Cook, DuPage and Will counties		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:02:27 PM Eastern Daylight Time	08/03/2022 04:05:33 PM Eastern Daylight Time	07/30/2022 06:15:00 AM Eastern Daylight Time			08/04/2022 11:23:43 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Community Select (HMO)	01	01		1			H1468	018	0	2023	Chicago area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H1468_019_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 04:03:50 PM Eastern Daylight Time	08/03/2022 04:08:48 PM Eastern Daylight Time	07/30/2022 06:15:26 AM Eastern Daylight Time			08/04/2022 11:23:43 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Together in Health (HMO-POS I-SNP)	01	02		1			H1468	019	0	2023	Chicago Area		2		2			1	1	1							https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H1468_020_0	3	1		1	1		1	08/02/2022	2023.01	08/02/2022 11:59:07 AM Eastern Daylight Time	08/03/2022 04:19:31 PM Eastern Daylight Time	07/30/2022 06:15:50 AM Eastern Daylight Time			08/04/2022 11:23:43 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Senior Living Plan (HMO-POS I-SNP)	01	02		1			H1468	020	0	2023	Chicago Area		2		2			1	1	2							https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/27/2022	2023.01	05/27/2022 03:36:27 PM Eastern Daylight Time					05/27/2022 03:49:53 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	802	0	2023	Select counties in Peoria Metro area		1	93777	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 03:40:01 PM Eastern Daylight Time					05/27/2022 03:49:53 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	803	0	2023	Select counties in Peoria Metro area		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/27/2022	2023.01	05/27/2022 03:43:51 PM Eastern Daylight Time					05/27/2022 03:49:53 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	805	0	2023	Select counties in Peoria Metro area		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 03:47:22 PM Eastern Daylight Time					05/27/2022 03:49:53 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	806	0	2023	Select counties in Peoria Metro area		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						06/01/2022	2023.01	06/01/2022 01:08:27 PM Eastern Daylight Time		06/01/2022 12:58:37 PM Eastern Daylight Time			06/01/2022 01:11:26 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	2023	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						06/01/2022	2023.01	06/01/2022 01:08:49 PM Eastern Daylight Time		06/01/2022 12:58:52 PM Eastern Daylight Time			06/01/2022 01:11:26 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	2023	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						06/01/2022	2023.01	06/01/2022 01:04:37 PM Eastern Daylight Time		05/26/2022 04:59:02 PM Eastern Daylight Time			06/01/2022 01:08:39 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	2023	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						06/01/2022	2023.01	06/01/2022 01:05:31 PM Eastern Daylight Time		05/26/2022 05:03:48 PM Eastern Daylight Time			06/01/2022 01:08:39 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	2023	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						06/05/2022	2023.01	06/05/2022 10:52:40 AM Eastern Daylight Time		06/05/2022 10:36:57 AM Eastern Daylight Time			06/05/2022 10:54:51 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	2023	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						06/05/2022	2023.01	06/05/2022 10:53:14 AM Eastern Daylight Time		06/05/2022 10:36:54 AM Eastern Daylight Time			06/05/2022 10:54:51 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	2023	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						06/04/2022	2023.01	06/04/2022 09:58:05 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	Nationwide		1	24624	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	06/04/2022	2023.01	06/04/2022 09:58:44 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:00:16 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:06:52 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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	06/04/2022	2023.01	06/04/2022 10:07:02 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:07:12 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:06:32 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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	06/04/2022	2023.01	06/04/2022 10:07:36 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:08:07 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:08:32 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:08:55 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:09:18 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:09:43 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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	06/04/2022	2023.01	06/04/2022 10:10:06 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:10:33 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:10:57 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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	06/04/2022	2023.01	06/04/2022 10:11:18 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:11:42 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:12:04 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:12:26 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:12:46 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:13:05 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:13:31 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:13:54 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	Nationwide		1	264	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	06/04/2022	2023.01	06/04/2022 10:14:20 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:14:57 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:15:18 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:15:38 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:16:05 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:17:29 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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						06/04/2022	2023.01	06/04/2022 10:18:16 AM Central Daylight Time					06/04/2022 10:35:12 AM 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	2023	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	843	0	1	04	01	H1537_843_0	1	1						06/04/2022	2023.01	06/04/2022 10:23:30 AM Central Daylight Time					06/04/2022 10:35:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	843	0	2023	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						05/31/2022	2023.01	05/31/2022 02:31:02 PM Mountain Daylight Time		05/31/2022 02:30:42 PM Mountain Daylight Time			05/31/2022 02:33:59 PM Mountain Daylight Time	LA COAST PACE, LLC	WelbeHealth Coastline PACE	https://welbehealth.com/locations/	WelbeHealth Coastline PACE (PACE)	08	20		1			H1544	001	0	2023	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						05/31/2022	2023.01	05/31/2022 02:31:09 PM Mountain Daylight Time		05/31/2022 02:32:38 PM Mountain Daylight Time			05/31/2022 02:33:59 PM Mountain Daylight Time	LA COAST PACE, LLC	WelbeHealth Coastline PACE	https://welbehealth.com/locations/	WelbeHealth Coastline PACE (PACE)	08	20		1			H1544	002	0	2023	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	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 11:43:56 AM Central Daylight Time	08/05/2022 10:10:12 AM Central Daylight Time	08/05/2022 10:10:13 AM Central Daylight Time			08/05/2022 10:15:41 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	2023	Arkansas		2		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	7	1		1				06/16/2022	2023.01	06/16/2022 03:56:51 PM Central Daylight Time	08/05/2022 10:10:14 AM Central Daylight Time	08/05/2022 10:10:16 AM Central Daylight Time			08/05/2022 10:19:03 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	2023	Arkansas		2		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	5	1					0	08/01/2022	2023.01	08/01/2022 03:17:08 PM Eastern Daylight Time	08/04/2022 06:16:30 PM Eastern Daylight Time	08/04/2022 06:29:32 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1					1	08/01/2022	2023.01	08/01/2022 03:49:58 PM Eastern Daylight Time	08/04/2022 06:16:31 PM Eastern Daylight Time	08/04/2022 06:29:35 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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						05/23/2022	2023.01	05/23/2022 02:04:11 PM Pacific Daylight Time					06/03/2022 10:15:30 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	2023	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;15;16b;18a;	2		1									
H1607	811	0	1	04	01	H1607_811_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:04:21 PM Pacific Daylight Time					06/03/2022 10:15:30 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	2023	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;15;16b;18a;	2		1									
H1607	812	0	1	04	01	H1607_812_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:04:30 PM Pacific Daylight Time					06/03/2022 10:15:30 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	2023	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;15;16b;18a;	2		1									
H1607	813	0	1	04	01	H1607_813_0	2	1						05/23/2022	2023.01	05/23/2022 02:04:40 PM Pacific Daylight Time					06/03/2022 10:15:30 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	2023	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;15;16b;18a;	2		1									
H1607	815	0	1	04	01	H1607_815_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:04:50 PM Pacific Daylight Time					06/03/2022 10:15:30 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	2023	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;15;16b;18a;	2		1									
H1607	816	0	1	04	01	H1607_816_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:05:00 PM Pacific Daylight Time					06/03/2022 10:15:30 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	2023	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;15;16b;18a;	2		1									
H1607	817	0	2	04	01	H1607_817_0	2	1						05/23/2022	2023.01	05/23/2022 02:05:11 PM Pacific Daylight Time					06/03/2022 10:15:30 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	2023	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;15;16b;18a;	2		1									
H1607	819	0	2	04	01	H1607_819_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:05:24 PM Pacific Daylight Time					06/03/2022 10:15:30 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	2023	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;15;16b;18a;	2		1									
H1607	820	0	2	04	01	H1607_820_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:05:33 PM Pacific Daylight Time					06/03/2022 10:15:30 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	2023	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;15;16b;18a;	2		1									
H1608	001	0	1	04	01	H1608_001_0	3	1			2		0	08/01/2022	2023.01	08/01/2022 01:01:02 PM Central Daylight Time	08/02/2022 12:43:28 PM Central Daylight Time	07/31/2022 07:57:28 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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	012	0	1	04	01	H1608_012_0	3	1			2		0	08/01/2022	2023.01	08/01/2022 01:01:18 PM Central Daylight Time	08/02/2022 12:44:18 PM Central Daylight Time	07/31/2022 07:57:56 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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	3	1						05/31/2022	2023.01	05/31/2022 02:50:31 PM Central Daylight Time	08/02/2022 01:15:43 PM Central Daylight Time	07/31/2022 07:58:24 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	Missouri/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	016	0	1	04	01	H1608_016_0	3	1						08/02/2022	2023.01	08/02/2022 05:52:33 PM Central Daylight Time	08/02/2022 04:18:01 PM Central Daylight Time	07/31/2022 07:58:52 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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	3	1						08/02/2022	2023.01	08/02/2022 05:56:27 PM Central Daylight Time	08/02/2022 04:19:07 PM Central Daylight Time	07/31/2022 07:59:18 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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	3	1						08/02/2022	2023.01	08/02/2022 05:56:54 PM Central Daylight Time	08/02/2022 04:20:20 PM Central Daylight Time	07/31/2022 07:59:46 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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	3	1						08/02/2022	2023.01	08/02/2022 05:57:17 PM Central Daylight Time	08/02/2022 04:21:44 PM Central Daylight Time	07/31/2022 08:00:14 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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	3	1						08/02/2022	2023.01	08/02/2022 05:57:38 PM Central Daylight Time	08/02/2022 04:22:54 PM Central Daylight Time	07/31/2022 08:00:42 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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	2	1			2		1	05/31/2022	2023.01	05/31/2022 11:05:04 AM Eastern Daylight Time	08/03/2022 12:14:43 PM Eastern Daylight Time	07/31/2022 09:01:08 PM Eastern Daylight Time			08/04/2022 04:29:22 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	2023	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	2	1			1		1	05/31/2022	2023.01	05/31/2022 11:12:38 AM Eastern Daylight Time	08/03/2022 12:16:22 PM Eastern Daylight Time	07/31/2022 09:01:36 PM Eastern Daylight Time			08/04/2022 04:29:22 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	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 08:18:34 AM Eastern Daylight Time	08/03/2022 11:54:56 AM Eastern Daylight Time	07/31/2022 09:02:04 PM Eastern Daylight Time			08/04/2022 04:25:53 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	2023	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	2	1			2		0	08/03/2022	2023.01	08/03/2022 10:17:59 AM Eastern Daylight Time	08/03/2022 08:35:39 AM Eastern Daylight Time	07/31/2022 09:02:30 PM Eastern Daylight Time			08/04/2022 06:24:40 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	2023	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	05/31/2022	2023.01	05/31/2022 11:27:40 AM Eastern Daylight Time	08/03/2022 12:18:03 PM Eastern Daylight Time	07/31/2022 09:03:06 PM Eastern Daylight Time			08/04/2022 04:29:22 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	2023	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						05/31/2022	2023.01	05/31/2022 02:51:23 PM Central Daylight Time	08/02/2022 01:16:42 PM Central Daylight Time	07/31/2022 08:03:34 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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			2		0	08/01/2022	2023.01	08/01/2022 01:01:40 PM Central Daylight Time	08/02/2022 12:45:08 PM Central Daylight Time	07/31/2022 08:04:02 PM Central Daylight Time			08/04/2022 09:28:54 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	2023	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			2		0	08/01/2022	2023.01	08/01/2022 01:01:59 PM Central Daylight Time	08/02/2022 12:46:02 PM Central Daylight Time	07/31/2022 08:04:30 PM Central Daylight Time			08/04/2022 09:28:54 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	2023	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						08/02/2022	2023.01	08/02/2022 05:58:17 PM Central Daylight Time	08/02/2022 04:24:06 PM Central Daylight Time	07/31/2022 08:04:58 PM Central Daylight Time			08/04/2022 09:28:54 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	2023	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	08/02/2022	2023.01	08/02/2022 04:42:50 PM Eastern Daylight Time	08/03/2022 12:19:37 PM Eastern Daylight Time	07/31/2022 09:05:28 PM Eastern Daylight Time			08/04/2022 04:29:22 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	2023	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	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:39:24 PM Eastern Daylight Time	08/03/2022 12:21:14 PM Eastern Daylight Time	07/31/2022 09:05:56 PM Eastern Daylight Time			08/10/2022 03:19:02 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	2023	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			2		0	08/01/2022	2023.01	08/01/2022 01:02:47 PM Central Daylight Time	08/02/2022 12:46:51 PM Central Daylight Time	07/31/2022 08:06:24 PM Central Daylight Time			08/04/2022 09:28:54 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	2023	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						08/02/2022	2023.01	08/02/2022 05:58:34 PM Central Daylight Time	08/02/2022 04:25:17 PM Central Daylight Time	07/31/2022 08:06:52 PM Central Daylight Time			08/04/2022 09:28:54 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	2023	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						08/02/2022	2023.01	08/02/2022 05:58:43 PM Central Daylight Time	08/02/2022 12:47:44 PM Central Daylight Time	07/31/2022 08:07:20 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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						08/02/2022	2023.01	08/02/2022 01:35:31 PM Central Daylight Time	08/02/2022 01:17:46 PM Central Daylight Time	07/31/2022 08:07:48 PM Central Daylight Time			08/04/2022 09:28:54 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	2023	Missouri/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	051	0	1	04	01	H1608_051_0	4	1						08/10/2022	2023.01	08/10/2022 02:12:30 PM Central Daylight Time	08/02/2022 01:18:45 PM Central Daylight Time	07/31/2022 08:08:16 PM Central Daylight Time			08/10/2022 02:25:56 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	2023	Southeast 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	052	0	1	04	01	H1608_052_0	3	1						08/02/2022	2023.01	08/02/2022 06:00:14 PM Central Daylight Time	08/02/2022 04:26:28 PM Central Daylight Time	07/31/2022 08:08:44 PM Central Daylight Time			08/04/2022 09:28:54 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	2023	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						08/02/2022	2023.01	08/02/2022 06:01:48 PM Central Daylight Time	08/02/2022 04:27:35 PM Central Daylight Time	07/31/2022 08:09:12 PM Central Daylight Time			08/04/2022 09:28:54 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	2023	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						08/02/2022	2023.01	08/02/2022 06:02:17 PM Central Daylight Time	08/02/2022 04:28:39 PM Central Daylight Time	07/31/2022 08:09:40 PM Central Daylight Time			08/04/2022 09:28:54 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	2023	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						08/10/2022	2023.01	08/10/2022 02:13:08 PM Central Daylight Time	08/02/2022 01:19:49 PM Central Daylight Time	07/31/2022 08:10:06 PM Central Daylight Time			08/10/2022 02:25:56 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	2023	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	3	1						08/02/2022	2023.01	08/02/2022 06:02:36 PM Central Daylight Time	08/02/2022 04:29:48 PM Central Daylight Time	07/31/2022 08:10:34 PM Central Daylight Time			08/04/2022 10:08:34 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	2023	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	061	0	1	04	01	H1608_061_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 08:07:40 PM Central Daylight Time	06/01/2022 12:38:26 PM Central Daylight Time				06/02/2022 02:26:07 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	2023	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1608	062	0	1	04	01	H1608_062_0	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:37:58 PM Central Daylight Time	08/02/2022 12:49:21 PM Central Daylight Time	07/31/2022 08:11:02 PM Central Daylight Time			08/04/2022 10:08:34 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier (PPO D-SNP)	01	04		1			H1608	062	0	2023	Partial State of South Dakota		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			
H1608	801	0	1	04	01	H1608_801_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 03:57:05 PM Eastern Daylight Time					06/02/2022 02:46:57 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	2023	Multi-State		1	14840	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	802	0	1	04	01	H1608_802_0	1	1						05/31/2022	2023.01	05/31/2022 03:57:44 PM Eastern Daylight Time					06/02/2022 02:46:57 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	2023	Multi-Plan		1	1880	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;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	08/01/2022	2023.01	08/01/2022 01:03:44 PM Central Daylight Time	08/02/2022 12:50:12 PM Central Daylight Time	07/31/2022 08:11:30 PM Central Daylight Time			08/04/2022 09:48:52 PM Central Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H1609	001	0	2023	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	016	0	1	01	01	H1609_016_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 01:22:44 PM Eastern Daylight Time	08/03/2022 03:05:49 PM Eastern Daylight Time	07/31/2022 09:11:58 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	016	0	2023	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	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:23:24 PM Eastern Daylight Time	08/03/2022 03:06:53 PM Eastern Daylight Time	07/31/2022 09:12:24 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	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	4	1			2		1	08/02/2022	2023.01	08/02/2022 01:23:18 PM Eastern Daylight Time	08/03/2022 03:07:57 PM Eastern Daylight Time	07/31/2022 09:12:52 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	018	0	2023	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	06/01/2022	2023.01	06/01/2022 12:07:02 PM Eastern Daylight Time	08/03/2022 03:09:04 PM Eastern Daylight Time	07/31/2022 09:13:20 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	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	4	1			2		1	08/02/2022	2023.01	08/02/2022 01:07:11 PM Eastern Daylight Time	08/03/2022 03:10:09 PM Eastern Daylight Time	07/31/2022 09:13:48 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	020	0	2023	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	4	1			2		1	08/02/2022	2023.01	08/02/2022 01:10:13 PM Eastern Daylight Time	08/03/2022 03:11:13 PM Eastern Daylight Time	07/31/2022 09:14:16 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	021	0	2023	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	4	1			2		1	08/02/2022	2023.01	08/02/2022 01:23:51 PM Eastern Daylight Time	08/03/2022 03:12:18 PM Eastern Daylight Time	07/31/2022 09:14:42 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	022	0	2023	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	025	0	1	01	01	H1609_025_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 01:12:42 PM Eastern Daylight Time	08/03/2022 03:13:25 PM Eastern Daylight Time	07/31/2022 09:15:10 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	025	0	2023	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	08/02/2022	2023.01	08/02/2022 01:13:23 PM Eastern Daylight Time	08/03/2022 03:14:31 PM Eastern Daylight Time	07/31/2022 09:15:38 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (HMO)	01	01		1			H1609	026	0	2023	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	08/02/2022	2023.01	08/02/2022 01:14:19 PM Eastern Daylight Time	08/03/2022 03:15:52 PM Eastern Daylight Time	07/31/2022 09:16:02 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	027	0	2023	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	08/02/2022	2023.01	08/02/2022 01:15:01 PM Eastern Daylight Time	08/03/2022 03:16:58 PM Eastern Daylight Time	07/31/2022 09:16:28 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice (HMO-POS)	01	02		1			H1609	028	0	2023	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	3	1			2		1	08/02/2022	2023.01	08/02/2022 01:15:35 PM Eastern Daylight Time	08/03/2022 03:18:03 PM Eastern Daylight Time	07/31/2022 09:16:54 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	034	0	2023	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	035	0	1	01	01	H1609_035_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 01:16:20 PM Eastern Daylight Time	08/03/2022 03:19:11 PM Eastern Daylight Time	07/31/2022 09:17:20 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	035	0	2023	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	038	0	1	01	01	H1609_038_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 01:16:59 PM Eastern Daylight Time	08/03/2022 03:20:21 PM Eastern Daylight Time	07/31/2022 09:17:44 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	038	0	2023	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	041	0	1	01	01	H1609_041_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 01:17:41 PM Eastern Daylight Time	08/03/2022 03:21:39 PM Eastern Daylight Time	07/31/2022 09:18:10 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	041	0	2023	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	08/02/2022	2023.01	08/02/2022 01:18:18 PM Eastern Daylight Time	08/03/2022 03:22:45 PM Eastern Daylight Time	07/31/2022 09:18:34 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	042	0	2023	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	06/01/2022	2023.01	06/01/2022 12:07:51 PM Eastern Daylight Time	08/03/2022 03:23:56 PM Eastern Daylight Time	07/31/2022 09:19:00 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	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	044	0	1	01	01	H1609_044_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:09:19 PM Eastern Daylight Time	08/03/2022 03:25:16 PM Eastern Daylight Time	07/31/2022 09:19:24 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	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	045	0	1	01	01	H1609_045_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:10:12 PM Eastern Daylight Time	08/03/2022 03:26:24 PM Eastern Daylight Time	07/31/2022 09:19:50 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	North FL, Treasure Coast 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	046	0	1	01	01	H1609_046_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:11:01 PM Eastern Daylight Time	08/03/2022 03:27:33 PM Eastern Daylight Time	07/31/2022 09:20:14 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	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	047	0	1	01	01	H1609_047_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:11:33 PM Eastern Daylight Time	08/03/2022 03:28:45 PM Eastern Daylight Time	07/31/2022 09:20:40 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	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	048	0	1	01	01	H1609_048_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:12:26 PM Eastern Daylight Time	08/03/2022 03:29:50 PM Eastern Daylight Time	07/31/2022 09:21:04 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	Palm Beach		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	049	0	1	01	01	H1609_049_0	5	1	2	1	1		0	07/12/2022	2023.01	07/12/2022 09:32:36 AM Eastern Daylight Time	08/03/2022 03:50:02 PM Eastern Daylight Time	07/31/2022 09:21:30 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	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	052	0	1	01	01	H1609_052_0	2	1			2	0	0	05/31/2022	2023.01	05/31/2022 07:44:16 PM Eastern Daylight Time	06/01/2022 01:48:13 PM Eastern Daylight Time				06/02/2022 12:10:14 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO)	01	01		1			H1609	052	0	2023	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			2		0	08/02/2022	2023.01	08/02/2022 01:19:03 PM Eastern Daylight Time	08/03/2022 03:32:33 PM Eastern Daylight Time	07/31/2022 09:21:54 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Credit (HMO)	01	01		1			H1609	053	0	2023	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	055	0	1	01	01	H1609_055_0	5	1	2	1	1		0	07/12/2022	2023.01	07/12/2022 09:33:23 AM Eastern Daylight Time	08/03/2022 03:33:39 PM Eastern Daylight Time	07/31/2022 09:22:20 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	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	056	0	1	01	01	H1609_056_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:14:51 PM Eastern Daylight Time	08/03/2022 03:34:46 PM Eastern Daylight Time	07/31/2022 09:22:44 PM Eastern Daylight Time			08/04/2022 05:26:58 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	2023	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	05/31/2022	2023.01	05/31/2022 05:10:35 PM Central Daylight Time	06/01/2022 12:42:18 PM Central Daylight Time				06/02/2022 02:49:43 PM Central Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO-POS)	01	02		1			H1609	058	0	2023	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1609	059	0	1	01	01	H1609_059_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 01:24:20 PM Eastern Daylight Time	08/03/2022 03:39:58 PM Eastern Daylight Time	07/31/2022 09:23:10 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	059	0	2023	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	08/02/2022	2023.01	08/02/2022 01:21:01 PM Eastern Daylight Time	08/03/2022 03:40:52 PM Eastern Daylight Time	07/31/2022 09:23:34 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Credit (HMO)	01	01		1			H1609	060	0	2023	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	061	0	1	01	01	H1609_061_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:16:00 PM Eastern Daylight Time	08/03/2022 03:43:37 PM Eastern Daylight Time	07/31/2022 09:24:00 PM Eastern Daylight Time			08/04/2022 05:26:58 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	061	0	2023	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	062	0	1	01	01	H1609_062_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:16:45 PM Eastern Daylight Time	08/03/2022 03:34:25 PM Eastern Daylight Time	07/31/2022 09:24:26 PM Eastern Daylight Time			08/04/2022 05:26:58 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	062	0	2023	Treasure Coast FL		2		2			1	3		2					2	www.aetnamedicare.com/findpharmacy	http://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	063	0	1	01	01	H1609_063_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 01:21:35 PM Eastern Daylight Time	08/03/2022 03:35:26 PM Eastern Daylight Time	07/31/2022 09:24:50 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	063	0	2023	Treasure Coast FL		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6770		(833)570-6770		(833)859-6031		(833)859-6031		(833)570-6770		(833)570-6770		(833)859-6031		(833)589-6031		(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	05/27/2022	2023.01	05/27/2022 09:03:21 AM Eastern Daylight Time					06/02/2022 02:53:49 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H1609	801	0	2023	Florida		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H1609	807	0	1	01	01	H1609_807_0	1	1						05/27/2022	2023.01	05/27/2022 09:07:46 AM Eastern Daylight Time					06/02/2022 02:53:49 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H1609	807	0	2023	Florida		1	1060	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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					2				
H1610	001	0	1	01	01	H1610_001_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:05:31 PM Eastern Daylight Time	08/02/2022 12:55:04 PM Eastern Daylight Time	07/31/2022 09:25:16 PM Eastern Daylight Time			08/05/2022 08:57:44 AM Eastern 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	2023	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		(844)934-3324		(844)934-3324		(855)463-0933		(855)463-0933		(844)934-3324		(844)934-3324		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1610	002	0	1	01	01	H1610_002_0	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 08:10:53 PM Eastern Daylight Time	08/02/2022 12:57:46 PM Eastern Daylight Time	07/31/2022 09:25:42 PM Eastern Daylight Time			08/05/2022 08:57:44 AM Eastern 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	2023	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	1		0	05/31/2022	2023.01	05/31/2022 08:11:24 PM Eastern Daylight Time	08/02/2022 12:59:31 PM Eastern Daylight Time	07/31/2022 09:26:06 PM Eastern Daylight Time			08/05/2022 08:57:44 AM Eastern 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	2023	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	2	1						06/01/2022	2023.01	06/01/2022 11:35:30 AM Pacific Daylight Time		06/01/2022 11:10:38 AM Pacific Daylight Time			06/01/2022 11:39:04 AM Pacific Daylight Time	NORTH EAST MEDICAL SERVICES	North East Medical Services - Program of All-Inclu	https://www.nems.org/pace/	NEMS PACE (PACE)	08	20		1			H1622	001	0	2023	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	2	1						06/01/2022	2023.01	06/01/2022 11:35:38 AM Pacific Daylight Time		06/01/2022 11:10:47 AM Pacific Daylight Time			06/01/2022 11:39:04 AM Pacific Daylight Time	NORTH EAST MEDICAL SERVICES	North East Medical Services - Program of All-Inclu	https://www.nems.org/pace/	NEMS PACE  Medicare Only (PACE)	08	20		1			H1622	003	0	2023	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	5	1		1				08/03/2022	2023.01	08/03/2022 09:34:35 PM Central Daylight Time	08/03/2022 09:22:54 PM Central Daylight Time	08/03/2022 10:07:43 PM Central Daylight Time			08/04/2022 02:26:49 PM 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	2023	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 08:59:05 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	80627	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 10:32:13 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 10:35:53 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	JoDaviess County		2	15372	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 10:07:39 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	46544	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 10:36:49 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	JoDaviess County		2	6400	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 10:55:22 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	10621	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 11:10:31 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	JoDaviess County		2	2822	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 11:25:46 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	Tama County		2	756	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 11:37:34 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	Central Iowa		2	630	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 11:53:29 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	Cedar, Clinton, Jackson and Scott Counties		2	604	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 12:02:17 PM Central Daylight Time					06/03/2022 08:10:31 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	2023	Cedar, Clinton, Jackson, Muscatine, Scott Counties		2	1212	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 12:12:17 PM Central Daylight Time					06/03/2022 08:10:31 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	2023	Cedar, Delaware, Jones and Linn Counties		2	9525	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 12:34:06 PM Central Daylight Time					06/03/2022 08:10:31 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	2023	North Iowa		2	5770	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 12:43:29 PM Central Daylight Time					06/03/2022 08:10:31 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	2023	Cedar and Muscatine Counties		2	100	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 12:53:03 PM Central Daylight Time					06/03/2022 08:10:31 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	2023	Mercer County		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	025	0	1	18	06	H1651_025_0	2	2				0	0	06/01/2022	2023.01	06/01/2022 01:00:17 PM Central Daylight Time					06/03/2022 08:10:31 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	2023	South Central Illinois		2	2488	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	2	1					1	08/02/2022	2023.01	08/02/2022 05:01:38 PM Central Daylight Time	08/03/2022 10:41:22 AM Central Daylight Time	07/31/2022 12:47:43 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Flex 1 (PPO)	01	04		1			H1659	002	0	2023	Select counties in Virginia		2		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	08/02/2022	2023.01	08/02/2022 08:48:58 AM Central Daylight Time	08/03/2022 10:42:05 AM Central Daylight Time	07/31/2022 12:48:07 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Flex 2 (PPO)	01	04		1			H1659	003	0	2023	Select counties in Virginia		2		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			2			08/01/2022	2023.01	08/01/2022 12:30:39 PM Eastern Daylight Time	08/03/2022 07:59:22 PM Eastern Daylight Time	07/30/2022 08:31:10 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select counties in MO		2		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			2			08/01/2022	2023.01	08/01/2022 12:31:58 PM Eastern Daylight Time	08/03/2022 08:00:28 PM Eastern Daylight Time	07/30/2022 08:31:41 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Section counties in MO		2		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	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 01:46:17 PM Eastern Daylight Time	08/03/2022 08:01:48 PM Eastern Daylight Time	07/30/2022 08:32:13 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select counties in MO		2		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			2			08/04/2022	2023.01	08/04/2022 05:35:53 PM Eastern Daylight Time	08/03/2022 08:02:55 PM Eastern Daylight Time	07/30/2022 08:32:45 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Section counties in MO		2		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			2			05/26/2022	2023.01	05/26/2022 10:52:51 AM Eastern Daylight Time	08/03/2022 08:03:59 PM Eastern Daylight Time	07/30/2022 08:33:17 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select counties in MO		2		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	1	1						05/10/2022	2023.01	05/10/2022 09:51:43 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	01	01		1			H1664	801	0	2023	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	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:51:49 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	01	01		1			H1664	802	0	2023	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	1	1						05/10/2022	2023.01	05/10/2022 09:51:54 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	01	01		1			H1664	803	0	2023	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	6	1						07/06/2022	2023.01	07/06/2022 01:56:40 PM Central Daylight Time	08/05/2022 02:27:42 PM Central Daylight Time	08/03/2022 05:32:49 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	001	0	2023	Austin Metro Area		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	002	0	1	04	01	H1666_002_0	6	1						07/06/2022	2023.01	07/06/2022 01:57:04 PM Central Daylight Time	08/05/2022 02:29:56 PM Central Daylight Time	08/03/2022 05:34:09 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	002	0	2023	Dallas Metro Area		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	003	0	1	04	01	H1666_003_0	6	1						07/06/2022	2023.01	07/06/2022 01:57:25 PM Central Daylight Time	08/05/2022 02:32:06 PM Central Daylight Time	08/03/2022 05:35:30 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	003	0	2023	Houston Metro Area		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	004	0	1	04	01	H1666_004_0	6	1						08/05/2022	2023.01	08/05/2022 02:36:07 PM Central Daylight Time	08/05/2022 02:34:20 PM Central Daylight Time	08/03/2022 05:36:51 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	004	0	2023	Austin Metro Area		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	005	0	1	04	01	H1666_005_0	6	1						08/05/2022	2023.01	08/05/2022 02:36:37 PM Central Daylight Time	08/05/2022 02:36:36 PM Central Daylight Time	08/03/2022 05:38:12 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	005	0	2023	Dallas Metro Area		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	006	0	1	04	01	H1666_006_0	6	1						08/05/2022	2023.01	08/05/2022 02:37:03 PM Central Daylight Time	08/05/2022 02:38:51 PM Central Daylight Time	08/03/2022 05:39:33 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	006	0	2023	Houston Metro Area		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	008	0	1	04	01	H1666_008_0	6	1						08/05/2022	2023.01	08/05/2022 02:37:24 PM Central Daylight Time	08/05/2022 02:41:06 PM Central Daylight Time	08/03/2022 05:40:53 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	008	0	2023	San Antonio Metro Area		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	010	0	1	04	01	H1666_010_0	6	1						08/05/2022	2023.01	08/05/2022 02:37:47 PM Central Daylight Time	08/05/2022 02:43:13 PM Central Daylight Time	08/03/2022 05:42:14 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	010	0	2023	El Paso		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	012	0	1	04	01	H1666_012_0	7	1						08/03/2022	2023.01	08/03/2022 03:09:03 PM Central Daylight Time	08/05/2022 02:45:43 PM Central Daylight Time	08/03/2022 05:43:33 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	012	0	2023	New Mexico		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	013	0	1	04	01	H1666_013_0	6	1						06/05/2022	2023.01	06/05/2022 06:22:43 PM Central Daylight Time	08/05/2022 02:48:04 PM Central Daylight Time	08/03/2022 05:44:52 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Flex Access (PPO)	01	04		1			H1666	013	0	2023	New Mexico		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	014	0	1	04	01	H1666_014_0	7	1						08/05/2022	2023.01	08/05/2022 02:35:14 PM Central Daylight Time	08/05/2022 02:50:34 PM Central Daylight Time	08/03/2022 05:46:12 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Health Choice (PPO)	01	04		1			H1666	014	0	2023	New Mexico		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	015	0	1	04	01	H1666_015_0	7	1						08/05/2022	2023.01	08/05/2022 02:38:16 PM Central Daylight Time	08/05/2022 02:44:09 PM Central Daylight Time	08/03/2022 05:47:32 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Saver Plus (PPO)	01	04		1			H1666	015	0	2023	New Mexico		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	016	0	1	04	01	H1666_016_0	7	1						08/05/2022	2023.01	08/05/2022 02:40:17 PM Central Daylight Time	08/05/2022 02:45:37 PM Central Daylight Time	08/03/2022 05:48:52 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluenm.com/mapd	Blue Cross Medicare Advantage Dental Premier (PPO)	01	04		1			H1666	016	0	2023	New Mexico		2		2			2									getbluenm.com/mapd/pharmacies	getbluenm.com/mapd/druglist	getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	018	0	1	04	01	H1666_018_0	5	1						08/03/2022	2023.01	08/03/2022 05:06:24 PM Central Daylight Time	08/05/2022 02:53:05 PM Central Daylight Time	08/03/2022 05:50:11 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Flex Access (PPO)	01	04		1			H1666	018	0	2023	Texas		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	801	0	1	04	01	H1666_801_0	3	1						06/02/2022	2023.01	06/02/2022 12:16:17 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	801	0	2023	State of Texas		1	34673	2			2									www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	803	0	1	04	01	H1666_803_0	3	1						06/02/2022	2023.01	06/02/2022 12:00:23 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	803	0	2023	State of Texas		1	1	2			2									www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	805	0	1	04	01	H1666_805_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 12:00:07 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	805	0	2023	State of Texas		1	1	2			2									www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	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	3	1						06/01/2022	2023.01	06/01/2022 11:59:53 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	807	0	2023	State of Texas		1	1	2			2									www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	808	0	1	04	01	H1666_808_0	3	1				0	0	06/01/2022	2023.01	06/01/2022 11:59:38 PM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of NM, TX	getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	808	0	2023	State of Texas		1	1	2			2									www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	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	3	1			2			08/10/2022	2023.01	08/10/2022 02:47:19 PM Eastern Daylight Time	08/03/2022 12:23:18 PM Eastern Daylight Time	07/31/2022 09:26:32 PM Eastern Daylight Time			08/10/2022 03:19:02 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	2023	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	02	01	H1692_003_0	3	1			2			08/02/2022	2023.01	08/02/2022 11:53:01 AM Eastern Daylight Time	08/03/2022 12:24:54 PM Eastern Daylight Time	07/31/2022 09:26:58 PM Eastern Daylight Time			08/04/2022 04:29:22 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	003	0	2023	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	005	0	1	01	01	H1692_005_0	2	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 01:47:02 PM Eastern Daylight Time	08/03/2022 12:27:08 PM Eastern Daylight Time	07/31/2022 09:27:22 PM Eastern Daylight Time			08/04/2022 04:29:22 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	2023	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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 11:53:14 AM Eastern Daylight Time	06/01/2022 02:28:58 PM Eastern Daylight Time				06/02/2022 12:35:46 PM 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	2023	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	007	0	1	01	01	H1692_007_0	2	1			2			08/02/2022	2023.01	08/02/2022 11:54:47 AM Eastern Daylight Time	08/03/2022 12:31:06 PM Eastern Daylight Time	07/31/2022 09:27:48 PM Eastern Daylight Time			08/04/2022 04:29:22 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Silver (HMO)	01	01		1			H1692	007	0	2023	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	801	0	1	01	01	H1692_801_0	1	1				0	0	06/02/2022	2023.01	06/02/2022 02:56:55 PM Eastern Daylight Time					06/02/2022 02:57:11 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	2023	West Virginia		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H1692	802	0	1	01	01	H1692_802_0	1	1						05/27/2022	2023.01	05/27/2022 09:13:31 AM Eastern Daylight Time					06/02/2022 02:57:11 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	2023	West Virginia		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H1693	002	0	1	20	08	H1693_002_0	1	1						06/01/2022	2023.01	06/01/2022 10:08:07 AM Pacific Daylight Time		05/31/2022 04:38:16 PM Pacific Daylight Time			06/01/2022 10:11:15 AM Pacific Daylight Time	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	Family Health-Center for Older Adults	www.fhcsd.org/pace	FamilyHealth - Center for Older Adults (PACE)	08	20		1			H1693	002	0	2023	San Diego		2		2			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						06/01/2022	2023.01	06/01/2022 10:09:19 AM Pacific Daylight Time		05/31/2022 04:38:16 PM Pacific Daylight Time			06/01/2022 10:11:15 AM Pacific Daylight Time	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	Family Health-Center for Older Adults	www.fhcsd.org/pace	FamilyHealth-Center for Older Adults-Medicare-only (PACE)	08	20		1			H1693	003	0	2023	San Diego		2		2			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						06/01/2022	2023.01	06/01/2022 12:03:50 PM Central Daylight Time		05/27/2022 10:15:34 AM Central Daylight Time			06/01/2022 12:12:02 PM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	Ascension Living HOPE	ascensionliving.org/hope	Ascension Living HOPE (PACE)	08	20		1			H1714	001	0	2023	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						06/01/2022	2023.01	06/01/2022 12:04:32 PM Central Daylight Time		05/27/2022 10:15:43 AM Central Daylight Time			06/01/2022 12:12:02 PM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	Ascension Living HOPE	ascensionliving.org/hope	Ascension Living HOPE (PACE)	08	20		1			H1714	002	0	2023	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	10	1					1	08/05/2022	2023.01	08/05/2022 01:02:01 PM Eastern Daylight Time	08/04/2022 08:48:58 PM Eastern Daylight Time	08/04/2022 05:29:18 PM Eastern Daylight Time			08/05/2022 02:15:51 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Signature (HMO)	01	01		1			H1722	002	0	2023	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	3	1						10/27/2022	2023.01	10/27/2022 03:31:46 PM Eastern Daylight Time					10/27/2022 03:48:47 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	2023	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	06/09/2022	2023.01	06/09/2022 06:25:17 PM Eastern Daylight Time	08/04/2022 06:15:16 PM Eastern Daylight Time	08/04/2022 06:27:13 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	Select Counties in NY		2		2			1	3		1					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	5	1	2	1	1		0	06/13/2022	2023.01	06/13/2022 05:22:01 PM Eastern Daylight Time	08/04/2022 06:15:18 PM Eastern Daylight Time	08/04/2022 06:27:15 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	Select Counties in NY		2		2			1	3		1					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	08/01/2022	2023.01	08/01/2022 12:30:17 PM Eastern Daylight Time	08/04/2022 06:17:56 PM Eastern Daylight Time	08/04/2022 06:32:15 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2		1	07/11/2022	2023.01	07/11/2022 09:55:00 AM Eastern Daylight Time	08/04/2022 06:17:58 PM Eastern Daylight Time	08/04/2022 06:32:17 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2		1	07/11/2022	2023.01	07/11/2022 09:55:09 AM Eastern Daylight Time	08/04/2022 06:17:59 PM Eastern Daylight Time	08/04/2022 06:32:20 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	7	1			2		1	08/01/2022	2023.01	08/01/2022 12:34:33 PM Eastern Daylight Time	08/04/2022 06:18:01 PM Eastern Daylight Time	08/04/2022 06:32:23 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 12:36:27 PM Central Daylight Time	08/05/2022 09:52:57 AM Central Daylight Time	08/05/2022 09:52:59 AM Central Daylight Time			08/05/2022 10:35:51 AM 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	2023	Scott County		2		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	2	1				0	0	04/27/2022	2023.01	04/27/2022 09:11:13 AM Central Daylight Time					06/03/2022 08:13:14 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1737	801	0	2023	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;9b;10a;11a;11b;15;	1	2;	1					1				
H1737	802	0	1	01	01	H1737_802_0	2	1						04/27/2022	2023.01	04/27/2022 09:11:31 AM Central Daylight Time					06/03/2022 08:13:14 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H1737	802	0	2023	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;9b;10a;11a;11b;15;	1	2;	1					1				
H1737	803	0	1	01	01	H1737_803_0	2	1						04/27/2022	2023.01	04/27/2022 09:11:47 AM Central Daylight Time					06/03/2022 08:13:14 AM Central 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	2023	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;9b;10a;11a;11b;15;	1	2;	1					1				
H1742	001	0	1	20	08	H1742_001_0	1	1						01/13/2023	2023.01	01/13/2023 01:36:34 PM Eastern Standard Time		01/11/2023 02:48:50 PM Eastern Standard Time			01/13/2023 01:39:22 PM Eastern Standard Time	ASCENSION LIVING ST. VINCENT PACE, INC.	Ascension Living St. Vincent PACE	https://ascension.org/stvincentpace	Ascension Living St. Vincent PACE (PACE)	08	20		1			H1742	001	0	2023	Northern Indianapolis and counties		2		2			2									ascensionliving.org/SVP	ascensionliving.org/SVP												(317)754-4865				(317)754-4565												(317)754-4570				(317)754-4570																
H1742	002	0	1	20	08	H1742_002_0	1	1						01/13/2023	2023.01	01/13/2023 01:37:12 PM Eastern Standard Time		01/11/2023 02:49:23 PM Eastern Standard Time			01/13/2023 01:39:22 PM Eastern Standard Time	ASCENSION LIVING ST. VINCENT PACE, INC.	Ascension Living St. Vincent PACE	https://ascensionliving.org/stvincentpace	Ascension Living St. Vincent PACE (PACE)	08	20		1			H1742	002	0	2023	Northern Indianapolis and counties		2		2			2									ascensionliving.org/SVP	ascensionliving.org/SVP												(317)754-4565				(317)754-4565												(317)754-4570				(317)754-4570																
H1748	001	0	1	01	01	H1748_001_0	6	1					1	08/03/2022	2023.01	08/03/2022 12:38:26 PM Eastern Daylight Time	08/03/2022 12:23:27 PM Eastern Daylight Time	08/03/2022 12:28:32 PM Eastern Daylight Time			08/03/2022 02:37:54 PM 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	2023	Cobb, DeKalb, Gwinnett, Fulton Counties		2		2			2									www.sonderhealthplans.com	www.sonderhealthplans.com	www.sonderhealthplans.com	(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1748	003	0	1	01	01	H1748_003_0	6	1		1			1	08/03/2022	2023.01	08/03/2022 12:39:25 PM Eastern Daylight Time	08/03/2022 12:24:13 PM Eastern Daylight Time	08/03/2022 12:29:10 PM Eastern Daylight Time			08/03/2022 02:37:54 PM 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	2023	Cobb, DeKalb, Gwinnett, Fulton Counties		2		2			1	4			00000010000000000000000					www.sonderhealthplans.com	www.sonderhealthplans.com	www.sonderhealthplans.com	(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1748	004	0	1	01	01	H1748_004_0	6	1		1			1	08/03/2022	2023.01	08/03/2022 12:40:16 PM Eastern Daylight Time	08/03/2022 12:25:01 PM Eastern Daylight Time	08/03/2022 12:29:47 PM Eastern Daylight Time			08/03/2022 02:37:54 PM 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	2023	Cobb, DeKalb, Gwinnett, Fulton Counties		2		2			1	4			00010000000000000000000					www.sonderhealthplans.com	www.sonderhealthplans.com	www.sonderhealthplans.com	(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1748	005	0	1	01	01	H1748_005_0	6	1	2	1			0	08/03/2022	2023.01	08/03/2022 12:41:07 PM Eastern Daylight Time	08/03/2022 12:25:43 PM Eastern Daylight Time	08/03/2022 12:30:21 PM Eastern Daylight Time			08/03/2022 02:37:54 PM 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	2023	Cobb, DeKalb, Gwinnett, Fulton Counties		2		2			1	3		1					1	www.sonderhealthplans.com	www.sonderhealthplans.com	www.sonderhealthplans.com	(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(888)428-4440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1774	001	0	1	04	01	H1774_001_0	5	1						08/01/2022	2023.01	08/01/2022 12:37:21 PM Central Daylight Time	08/03/2022 08:30:01 PM Eastern Daylight Time	07/30/2022 08:33:49 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern 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	2023	Central, Southeast and Southwest Indiana Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1774	002	0	1	04	01	H1774_002_0	5	1						08/01/2022	2023.01	08/01/2022 12:38:15 PM Central Daylight Time	08/03/2022 08:33:47 PM Eastern Daylight Time	07/30/2022 08:34:21 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY INDIANA, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent Access (PPO)	01	04		1			H1774	002	0	2023	Central, Southeast and Southwest Indiana		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1777	007	0	1	01	01	H1777_007_0	6	1		1	1			08/04/2022	2023.01	08/04/2022 06:19:39 PM Eastern Daylight Time	08/05/2022 09:08:08 AM Eastern Daylight Time	08/05/2022 09:08:40 AM Eastern Daylight Time			08/05/2022 09:10:21 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	2023	NYC, Westchester, Putnam, Dutchess, Orange, Ononda		2		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	5	1		1				08/02/2022	2023.01	08/02/2022 08:11:25 PM Central Daylight Time	08/03/2022 11:34:40 AM Central Daylight Time	08/02/2022 11:01:35 AM Central Daylight Time			08/04/2022 12:49:43 PM 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	2023	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		(855)800-8872		(855)800-8872		(844)637-4760		(844)637-4760		(888)279-1549		(888)279-1549		(888)279-1549		(888)279-1549		(711)-		(711)-		(888)279-1549		(888)279-1549		2					2					2	2			
H1787	002	0	1	01	01	H1787_002_0	5	1		1				08/02/2022	2023.01	08/02/2022 08:11:55 PM Central Daylight Time	08/03/2022 11:35:15 AM Central Daylight Time	08/02/2022 11:03:01 AM Central Daylight Time			08/04/2022 12:49:43 PM 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	2023	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		(855)800-8872		(855)800-8872		(844)637-4760		(844)637-4760		(888)279-1549		(888)279-1549		(888)279-1549		(888)279-1549		(711)-		(711)-		(888)279-1549		(888)279-1549		2					2					2	2			
H1799	001	0	1	01	01	H1799_001_0	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:26:40 PM Pacific Daylight Time	08/04/2022 05:55:12 PM Pacific Daylight Time	08/01/2022 10:27:14 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF KENTUCKY, INC.	Passport Advantage	www.molinahealthcare.com/medicare	Passport Advantage (HMO D-SNP)	01	01		1			H1799	001	0	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 05:26:56 PM Pacific Daylight Time	08/04/2022 05:55:40 PM Pacific Daylight Time	08/01/2022 10:27:44 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 10:20:32 AM Central Daylight Time	08/03/2022 11:38:57 AM Central Daylight Time	07/31/2022 12:48:32 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1821	001	0	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 10:26:03 AM Central Daylight Time	08/03/2022 11:39:35 AM Central Daylight Time	07/31/2022 12:48:56 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H1821	002	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 01:37:34 PM Central Daylight Time	08/03/2022 11:40:12 AM Central Daylight Time	07/31/2022 12:49:20 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1821	003	0	2023	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	004	0	1	04	01	H1821_004_0	1	1				0	0	06/02/2022	2023.01	06/02/2022 09:05:17 AM Central Daylight Time	06/01/2022 10:42:38 AM Central Daylight Time				06/03/2022 10:34:06 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H1821	004	0	2023	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	2	1					1	05/31/2022	2023.01	05/31/2022 10:29:38 AM Central Daylight Time	08/03/2022 11:40:49 AM Central Daylight Time	07/31/2022 12:49:45 AM Central Daylight Time			08/04/2022 03:01:33 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H1821	005	0	2023	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	8	1					1	08/03/2022	2023.01	08/03/2022 02:28:24 PM Pacific Daylight Time	08/03/2022 07:43:38 PM Pacific Daylight Time	08/02/2022 09:58:14 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scandeserthealthplan.com	SCAN Classic (HMO)	01	01		1			H1822	001	0	2023	Maricopa, Pima and Pinal Counties		2		2			2									www.scandeserthealthplan.com	www.scandeserthealthplan.com	www.scandeserthealthplan.com	(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7c;7e1;7e2;7h1;7h2;7i;17a;	
H1822	002	0	1	01	01	H1822_002_0	8	1		1			1	08/03/2022	2023.01	08/03/2022 02:29:35 PM Pacific Daylight Time	08/03/2022 07:44:11 PM Pacific Daylight Time	08/02/2022 09:58:27 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scandeserthealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H1822	002	0	2023	Maricopa, Pima and Pinal Counties		2		2			1	4			00000010000000000000000					www.scandeserthealthplan.com	www.scandeserthealthplan.com	www.scandeserthealthplan.com	(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7c;7e1;7e2;7h1;7h2;7i;17a;	
H1822	003	0	1	01	01	H1822_003_0	8	1		1			1	08/03/2022	2023.01	08/03/2022 02:31:49 PM Pacific Daylight Time	08/03/2022 07:44:43 PM Pacific Daylight Time	08/02/2022 09:58:41 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scandeserthealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H1822	003	0	2023	Maricopa, Pima and Pinal Counties		2		2			1	4			00000000000000010000000					www.scandeserthealthplan.com	www.scandeserthealthplan.com	www.scandeserthealthplan.com	(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7c;7e1;7e2;7h1;7h2;7i;17a;	
H1822	004	0	1	01	01	H1822_004_0	9	1					1	08/03/2022	2023.01	08/03/2022 02:33:38 PM Pacific Daylight Time	08/03/2022 07:45:16 PM Pacific Daylight Time	08/02/2022 09:58:55 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scandeserthealthplan.com	SCAN Venture (HMO)	01	01		1			H1822	004	0	2023	Maricopa, Pima and Pinal Counties		2		2			2									www.scandeserthealthplan.com	www.scandeserthealthplan.com	www.scandeserthealthplan.com	(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;17a;	
H1822	005	0	1	01	01	H1822_005_0	9	1		1			1	08/03/2022	2023.01	08/03/2022 03:56:57 PM Pacific Daylight Time	08/04/2022 11:42:47 AM Pacific Daylight Time	08/02/2022 09:59:09 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scandeserthealthplan.com	SCAN Embrace (HMO I-SNP)	01	01		1			H1822	005	0	2023	Maricopa and Pima Counties		2		2			1	1	3							www.scandeserthealthplan.com	www.scandeserthealthplan.com	www.scandeserthealthplan.com	(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1822	801	0	1	01	01	H1822_801_0	6	1						06/03/2022	2023.01	06/03/2022 09:20:03 AM Pacific Daylight Time					06/05/2022 04:42:03 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scandeserthealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H1822	801	0	2023	Maricopa, Pima and Pinal Counties		1	0	2			2									www.scandeserthealthplan.com	www.scandeserthealthplan.com	www.scandeserthealthplan.com	(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1822	802	0	1	01	01	H1822_802_0	6	1						06/03/2022	2023.01	06/03/2022 09:20:23 AM Pacific Daylight Time					06/05/2022 04:42:03 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scandeserthealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H1822	802	0	2023	Maricopa, Pima and Pinal Counties		1	0	2			2									www.scandeserthealthplan.com	www.scandeserthealthplan.com	www.scandeserthealthplan.com	(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(855)650-7226		(855)650-7226		(866)490-7226		(866)490-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1846	004	0	1	04	01	H1846_004_0	5	1					1	08/04/2022	2023.01	08/04/2022 09:04:16 AM Eastern Daylight Time	08/04/2022 05:53:32 PM Eastern Daylight Time	08/04/2022 05:53:32 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Mount Carmel Choice (PPO)	01	04		1			H1846	004	0	2023	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	4	1					0	08/04/2022	2023.01	08/04/2022 09:08:15 AM Eastern Daylight Time	08/04/2022 05:53:33 PM Eastern Daylight Time	08/04/2022 05:53:33 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Mount Carmel No Premium Choice (PPO)	01	04		1			H1846	005	0	2023	Central and Southwest 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	4	1					0	08/04/2022	2023.01	08/04/2022 09:11:27 AM Eastern Daylight Time	08/04/2022 05:53:33 PM Eastern Daylight Time	08/04/2022 05:53:34 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Mount Carmel No Premium Choice (PPO)	01	04		1			H1846	006	0	2023	Northwest 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	4	1					1	08/04/2022	2023.01	08/04/2022 10:16:48 AM Eastern Daylight Time	08/04/2022 05:53:34 PM Eastern Daylight Time	08/04/2022 05:53:35 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	MediGold MercyOne Medicare Plan No Premium Choice (PPO)	01	04		1			H1846	007	0	2023	Select Counties in Iowa		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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	2	1						05/26/2022	2023.01	05/26/2022 11:37:25 AM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Mount Carmel Choice EGWP 1 (PPO)	01	04		1			H1846	801	0	2023	Central, Southwest, and Northwest 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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H1846	803	0	1	04	01	H1846_803_0	2	1						05/26/2022	2023.01	05/26/2022 11:45:53 AM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Mount Carmel Choice EGWP 2 (PPO)	01	04		1			H1846	803	0	2023	Central, Southwest, and Northwest 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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H1846	804	0	1	04	01	H1846_804_0	2	1						05/26/2022	2023.01	05/26/2022 11:53:09 AM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	MediGold MercyOne Medicare Plan Choice EGWP 1 (PPO)	01	04		1			H1846	804	0	2023	Select Counties in Iowa		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H1846	805	0	1	04	01	H1846_805_0	2	1						05/26/2022	2023.01	05/26/2022 12:00:37 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	MediGold MercyOne Medicare Plan Choice EGWP 2 (PPO)	01	04		1			H1846	805	0	2023	Select Counties in Iowa		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H1848	001	0	1	04	01	H1848_001_0	4	1						05/31/2022	2023.01	05/31/2022 10:15:35 AM Eastern Daylight Time	08/03/2022 09:00:52 PM Eastern Daylight Time	07/30/2022 08:34:52 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H1848	001	0	2023	Select counties in AL		2		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	4	1						08/01/2022	2023.01	08/01/2022 12:17:21 PM Eastern Daylight Time	08/03/2022 09:02:01 PM Eastern Daylight Time	07/30/2022 08:35:23 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H1848	002	0	2023	Select counties in AL		2		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	1		0	07/05/2022	2023.01	07/05/2022 11:12:50 AM Eastern Daylight Time	08/03/2022 09:03:11 PM Eastern Daylight Time	07/30/2022 08:35:55 AM Eastern Daylight Time			08/04/2022 05:23:51 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	2023	Select counties in AL		2		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	4	1						08/01/2022	2023.01	08/01/2022 12:19:36 PM Eastern Daylight Time	08/03/2022 09:04:19 PM Eastern Daylight Time	07/30/2022 08:36:26 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium Open (PPO)	01	04		1			H1848	004	0	2023	Select counties in AL		2		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	4	1						08/02/2022	2023.01	08/02/2022 09:46:13 AM Eastern Daylight Time	08/03/2022 06:34:05 PM Central Daylight Time	07/30/2022 07:36:58 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1862	001	0	2023	Select counties in VT		2		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	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:12:52 AM Central Daylight Time	08/03/2022 10:37:54 AM Central Daylight Time	07/31/2022 12:50:09 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	002	1	2023	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	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:13:55 AM Central Daylight Time	08/03/2022 10:38:30 AM Central Daylight Time	07/31/2022 12:50:34 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	002	2	2023	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			
H1889	005	0	1	04	01	H1889_005_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 10:00:49 AM Central Daylight Time	08/03/2022 10:39:08 AM Central Daylight Time	07/31/2022 12:50:59 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	005	0	2023	State of North Carolina		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			
H1889	006	0	1	04	01	H1889_006_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 09:46:50 AM Central Daylight Time	08/03/2022 10:39:46 AM Central Daylight Time	07/31/2022 12:51:23 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	006	0	2023	State of 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			
H1889	007	0	1	04	01	H1889_007_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 12:51:40 PM Central Daylight Time	08/03/2022 10:40:23 AM Central Daylight Time	07/31/2022 12:51:48 AM Central Daylight Time			08/04/2022 04:13:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	007	0	2023	Select Counties in Pennsylvania		2		2			1	3		1					1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(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			
H1889	008	0	1	04	01	H1889_008_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 10:28:55 AM Central Daylight Time	08/03/2022 10:41:23 AM Central Daylight Time	07/31/2022 12:52:12 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	008	0	2023	State of Kentucky		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			
H1889	009	0	1	04	01	H1889_009_0	3	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 09:15:01 AM Central Daylight Time	08/03/2022 10:42:03 AM Central Daylight Time	07/31/2022 12:52:37 AM Central Daylight Time			08/12/2022 09:59:28 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	009	0	2023	Select Counties in Alabama		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			
H1889	010	0	1	04	01	H1889_010_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 02:22:27 PM Central Daylight Time	08/03/2022 10:42:42 AM Central Daylight Time	07/31/2022 12:53:01 AM Central Daylight Time			08/04/2022 03:43:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	010	0	2023	Select counties in Louisiana		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			
H1889	011	0	1	04	01	H1889_011_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:57:21 AM Central Daylight Time	08/03/2022 10:43:22 AM Central Daylight Time	07/31/2022 12:53:26 AM Central Daylight Time			08/04/2022 03:43:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	011	0	2023	Select counties in Mississippi		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			
H1894	001	0	1	01	01	H1894_001_0	7	1			2			09/27/2022	2023.01	09/27/2022 09:16:01 AM Pacific Daylight Time	08/04/2022 03:19:43 PM Pacific Daylight Time	08/04/2022 03:35:39 PM Pacific Daylight Time			09/27/2022 09:21:35 AM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	https://shop.amerigroup.com/medicare/	Amerivantage Classic (HMO)	01	01		1			H1894	001	0	2023	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	06/02/2022	2023.01	06/02/2022 02:31:14 PM Eastern Daylight Time	08/04/2022 06:15:20 PM Eastern Daylight Time	08/04/2022 06:27:18 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1		1	2			07/14/2022	2023.01	07/14/2022 01:27:09 PM Pacific Daylight Time	08/04/2022 03:19:44 PM Pacific Daylight Time	08/04/2022 03:35:42 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	https://shop.amerigroup.com/medicare/	Amerivantage Comfort (HMO I-SNP)	01	01		1			H1894	007	0	2023	King and Pierce Counties		2		2			1	1	3							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(833)681-2643		(833)681-2643		(855)593-0910		(855)593-0910		(833)293-5472		(833)293-5472		(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	6	1		1	2			08/02/2022	2023.01	08/02/2022 12:06:35 AM Pacific Daylight Time		08/04/2022 03:35:45 PM Pacific Daylight Time		08/04/2022 03:19:46 PM Pacific Daylight Time	08/19/2022 08:29:30 AM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	https://shop.amerigroup.com/medicare/	Amerivantage ESRD Care (HMO C-SNP)	01	01		1			H1894	008	0	2023	Select Counties in WA		2		2			1	4			00000000100000000000000					www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(833)681-2639		(833)681-2639		(855)593-0910		(855)593-0910		(833)293-5472		(833)293-5472		(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						06/03/2022	2023.01	06/03/2022 03:47:56 PM Central Daylight Time		06/03/2022 03:18:07 PM Central Daylight Time			06/03/2022 03:52:56 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	2023	PACE Greater New Orleans		2	1974	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						06/03/2022	2023.01	06/03/2022 03:51:33 PM Central Daylight Time		06/03/2022 03:18:07 PM Central Daylight Time			06/03/2022 03:52:56 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	2023	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	4	1						08/03/2022	2023.01	08/03/2022 02:09:12 PM Eastern Daylight Time	08/03/2022 06:35:18 PM Central Daylight Time	07/30/2022 07:37:29 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H1914	001	0	2023	All counties in CT		2		2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(833)444-9088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1914	002	0	1	04	01	H1914_002_0	4	1						08/03/2022	2023.01	08/03/2022 02:12:44 PM Eastern Daylight Time	08/03/2022 06:36:27 PM Central Daylight Time	07/30/2022 07:38:01 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H1914	002	0	2023	All counties in CT		2		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	4	1						07/14/2022	2023.01	07/14/2022 09:42:37 AM Central Daylight Time	08/03/2022 06:37:34 PM Central Daylight Time	07/30/2022 07:38:32 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H1914	004	0	2023	All counties in CT		2		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	006	0	1	04	01	H1914_006_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:46:37 AM Central Daylight Time	08/03/2022 06:38:41 PM Central Daylight Time	07/30/2022 07:39:07 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H1914	006	0	2023	All counties in CT		2		2			1	3		1					1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(833)444-9089		(833)444-9089		(833)444-9089		(833)444-9089		(833)444-9089		(833)444-9089		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1924	001	0		07	02	H1924_001_0	8	2				0	0	06/01/2022	2023.01	06/01/2022 01:38:16 PM Central Daylight Time			07/14/2022 09:25:01 AM Central Daylight Time		07/14/2022 11:27:29 AM Central Daylight Time	LASSO HEALTHCARE INSURANCE COMPANY	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare Growth (MSA)	02	07	2				H1924	001	0	2023	Various States		2		1	1		2												(833)925-2776		(833)925-2776		(833)925-2776		(833)925-2776										(711)-		(711)-		(711)-		(711)-																								
H1924	004	0		07	02	H1924_004_0	8	2				0	0	05/12/2022	2023.01	05/12/2022 10:30:47 AM Central Daylight Time			07/14/2022 09:25:02 AM Central Daylight Time		07/14/2022 11:27:29 AM Central Daylight Time	LASSO HEALTHCARE INSURANCE COMPANY	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare Growth Plus (MSA)	02	07	2				H1924	004	0	2023	Various States		2		1	1		2												(833)925-2776		(833)925-2776		(833)925-2776		(833)925-2776										(711)-		(711)-		(711)-		(711)-																								
H1924	817	0		07	02	H1924_817_0	6	2				0	0	05/12/2022	2023.01	05/12/2022 02:03:54 PM Central Daylight Time					06/22/2022 05:38:49 PM Central Daylight Time	LASSO HEALTHCARE INSURANCE COMPANY	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare EGWP CY (MSA)	02	07	2				H1924	817	0	2023	Various States		1	12000	1	1		2												(833)925-2776		(833)925-2776		(833)925-2776		(833)925-2776										(711)-		(711)-		(711)-		(711)-																								
H1924	818	0		07	02	H1924_818_0	6	2				0	0	05/12/2022	2023.01	05/12/2022 02:03:39 PM Central Daylight Time					06/22/2022 05:38:49 PM Central Daylight Time	LASSO HEALTHCARE INSURANCE COMPANY	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare EGWP NCY (MSA)	02	07	2				H1924	818	0	2023	Various State		1	12000	1	1		2												(833)925-2776		(833)925-2776		(833)925-2776		(833)925-2776										(711)-		(711)-		(711)-		(711)-																								
H1944	001	0	1	02	01	H1944_001_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:21:23 AM Central Daylight Time	08/03/2022 11:01:28 AM Central Daylight Time	07/31/2022 12:53:50 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H1944	001	0	2023	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	02	01	H1944_004_0	2	1					1	05/30/2022	2023.01	05/30/2022 04:02:02 PM Central Daylight Time	08/03/2022 11:02:19 AM Central Daylight Time	07/31/2022 12:54:14 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H1944	004	0	2023	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	02	01	H1944_005_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:24:08 AM Central Daylight Time	08/03/2022 11:03:09 AM Central Daylight Time	07/31/2022 12:54:39 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H1944	005	0	2023	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	02	01	H1944_006_0	2	1					1	06/01/2022	2023.01	06/01/2022 09:06:21 PM Central Daylight Time	08/03/2022 11:03:59 AM Central Daylight Time	07/31/2022 12:55:03 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H1944	006	0	2023	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	02	01	H1944_009_0	2	1					1	08/04/2022	2023.01	08/04/2022 12:40:34 PM Central Daylight Time	08/03/2022 11:04:50 AM Central Daylight Time	07/31/2022 12:55:27 AM Central Daylight Time			08/04/2022 04:22:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H1944	009	0	2023	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	02	01	H1944_010_0	2	1					1	08/04/2022	2023.01	08/04/2022 12:40:44 PM Central Daylight Time	08/03/2022 11:05:40 AM Central Daylight Time	07/31/2022 12:55:51 AM Central Daylight Time			08/04/2022 04:22:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 1 (HMO-POS)	01	02		1			H1944	010	0	2023	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	011	0	1	02	01	H1944_011_0	2	1					1	08/04/2022	2023.01	08/04/2022 12:41:00 PM Central Daylight Time	08/03/2022 11:06:31 AM Central Daylight Time	07/31/2022 12:56:15 AM Central Daylight Time			08/04/2022 04:22:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 2 (HMO-POS)	01	02		1			H1944	011	0	2023	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	014	0	1	02	01	H1944_014_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:25:57 AM Central Daylight Time	08/03/2022 11:07:20 AM Central Daylight Time	07/31/2022 12:56:40 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1944	014	0	2023	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	1	1				0	0	05/30/2022	2023.01	05/30/2022 04:07:57 PM Central Daylight Time	06/01/2022 10:48:36 AM Central Daylight Time				06/02/2022 02:17:17 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H1944	015	0	2023	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	08/02/2022	2023.01	08/02/2022 11:26:56 AM Central Daylight Time	08/03/2022 11:08:09 AM Central Daylight Time	07/31/2022 12:57:03 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex (HMO-POS)	01	02		1			H1944	016	0	2023	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	02	01	H1944_017_0	3	1					1	05/30/2022	2023.01	05/30/2022 04:10:46 PM Central Daylight Time	08/03/2022 11:08:59 AM Central Daylight Time	07/31/2022 12:57:28 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H1944	017	0	2023	State of 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	02	01	H1944_018_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:27:37 AM Central Daylight Time	08/03/2022 11:09:47 AM Central Daylight Time	07/31/2022 12:57:52 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H1944	018	0	2023	State of 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	02	01	H1944_024_0	2	1					1	08/04/2022	2023.01	08/04/2022 12:41:16 PM Central Daylight Time	08/03/2022 11:10:36 AM Central Daylight Time	07/31/2022 12:58:16 AM Central Daylight Time			08/04/2022 04:22:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex (HMO-POS)	01	02		1			H1944	024	0	2023	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	028	0	1	02	01	H1944_028_0	2	1					1	06/01/2022	2023.01	06/01/2022 09:06:40 PM Central Daylight Time	08/03/2022 11:11:25 AM Central Daylight Time	07/31/2022 12:58:40 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H1944	028	0	2023	State of 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	02	01	H1944_030_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 02:41:12 PM Central Daylight Time	06/01/2022 10:53:06 AM Central Daylight Time				06/02/2022 02:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H1944	030	0	2023	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	02	01	H1944_031_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:28:40 AM Central Daylight Time	08/03/2022 11:13:07 AM Central Daylight Time	07/31/2022 12:59:04 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H1944	031	0	2023	State of 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	02	01	H1944_032_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:29:31 AM Central Daylight Time	08/03/2022 11:14:03 AM Central Daylight Time	07/31/2022 12:59:29 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO-POS)	01	02		1			H1944	032	0	2023	State of 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	02	01	H1944_033_0	2	1					1	08/04/2022	2023.01	08/04/2022 12:52:00 PM Central Daylight Time	08/03/2022 11:14:55 AM Central Daylight Time	07/31/2022 12:59:53 AM Central Daylight Time			08/04/2022 04:22:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H1944	033	0	2023	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	034	0	1	02	01	H1944_034_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:30:14 AM Central Daylight Time	08/03/2022 11:15:45 AM Central Daylight Time	07/31/2022 01:00:17 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Northern Light Health Flex (HMO-POS)	01	02		1			H1944	034	0	2023	State of 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	2			
H1944	035	0	1	02	01	H1944_035_0	2	1					1	08/04/2022	2023.01	08/04/2022 12:52:24 PM Central Daylight Time	08/03/2022 11:16:35 AM Central Daylight Time	07/31/2022 01:00:41 AM Central Daylight Time			08/04/2022 04:22:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex (HMO-POS)	01	02		1			H1944	035	0	2023	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						06/03/2022	2023.01	06/03/2022 09:48:52 AM Central Daylight Time					06/03/2022 02:43:55 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	805	0	2023	Select counties in MA, NH, PA, RI, VT		1	2004	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	06/03/2022	2023.01	06/03/2022 09:49:11 AM Central Daylight Time					06/03/2022 02:43:55 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	806	0	2023	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						06/03/2022	2023.01	06/03/2022 09:49:22 AM Central Daylight Time					06/03/2022 02:43:55 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	807	0	2023	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	6	1	2	1	1		0	07/25/2022	2023.01	07/25/2022 09:46:40 AM Eastern Daylight Time	08/04/2022 06:16:33 PM Eastern Daylight Time	08/04/2022 06:29:37 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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			
H1947	003	0	1	01	01	H1947_003_0	7	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 09:43:34 AM Eastern Daylight Time	08/04/2022 06:16:34 PM Eastern Daylight Time	08/04/2022 06:29:40 PM Eastern Daylight Time			08/04/2022 09:35:16 PM Eastern Daylight Time	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Healthy Blue	shop.healthybluela.com/medicare	Healthy Blue Enhanced Care (HMO D-SNP)	01	01		1			H1947	003	0	2023	Select parishes in LA		2		2			1	3		2					2	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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:10:30 PM Eastern Daylight Time	08/03/2022 04:08:02 PM Eastern Daylight Time	07/30/2022 06:16:14 AM Eastern Daylight Time			08/04/2022 02:38:25 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	2023	Shreveport Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:00:03 PM Eastern Daylight Time	08/03/2022 03:47:09 PM Eastern Daylight Time	07/30/2022 06:16:40 AM Eastern Daylight Time			08/04/2022 03:01:01 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	2023	Tangipahoa Parish		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:00:32 PM Eastern Daylight Time	08/03/2022 03:48:05 PM Eastern Daylight Time	07/30/2022 06:17:04 AM Eastern Daylight Time			08/04/2022 03:01:01 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	2023	Washington and St. Tammany Parishes		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 04:00:46 PM Eastern Daylight Time	08/03/2022 03:49:30 PM Eastern Daylight Time	07/30/2022 06:17:30 AM Eastern Daylight Time			08/04/2022 03:01:01 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	2023	Baton Rouge Area		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 06:57:11 PM Eastern Daylight Time	08/03/2022 03:49:01 PM Eastern Daylight Time	07/30/2022 06:17:54 AM Eastern Daylight Time			08/04/2022 03:01:01 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	2023	New Orleans Area		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/18/2022	2023.01	07/18/2022 03:50:55 PM Eastern Daylight Time	08/03/2022 03:48:32 PM Eastern Daylight Time	07/30/2022 06:18:20 AM Eastern Daylight Time			08/04/2022 03:01:01 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	2023	Washington and St. Tammany Parishes		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/01/2022	2023.01	08/01/2022 04:01:24 PM Eastern Daylight Time	08/03/2022 03:50:28 PM Eastern Daylight Time	07/30/2022 06:18:44 AM Eastern Daylight Time			08/04/2022 03:01:01 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	2023	New Orleans Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/01/2022	2023.01	08/01/2022 04:02:39 PM Eastern Daylight Time	08/03/2022 03:49:59 PM Eastern Daylight Time	07/30/2022 06:19:08 AM Eastern Daylight Time			08/04/2022 03:01:01 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	2023	Baton Rouge Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 04:03:14 PM Eastern Daylight Time	08/03/2022 03:52:47 PM Eastern Daylight Time	07/30/2022 06:19:34 AM Eastern Daylight Time			08/04/2022 03:01:01 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	2023	Select Louisiana Parishes		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1		1	1		1	08/01/2022	2023.01	08/01/2022 04:03:41 PM Eastern Daylight Time	08/03/2022 03:51:51 PM Eastern Daylight Time	07/30/2022 06:19:58 AM Eastern Daylight Time			08/04/2022 03:01:01 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H1951	044	0	2023	Jefferson and Orleans Parishes		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:04:16 PM Eastern Daylight Time	08/03/2022 03:55:07 PM Eastern Daylight Time	07/30/2022 06:20:24 AM Eastern Daylight Time			08/04/2022 03:01:01 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	2023	New Orleans Area	New Orleans Area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:04:49 PM Eastern Daylight Time	08/03/2022 03:54:39 PM Eastern Daylight Time	07/30/2022 06:20:48 AM Eastern Daylight Time			08/04/2022 03:09:52 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	2023	New Orleans Area	New Orleans Area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 04:05:06 PM Eastern Daylight Time	08/03/2022 03:54:11 PM Eastern Daylight Time	07/30/2022 06:21:12 AM Eastern Daylight Time			08/04/2022 03:09:52 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	2023	Baton Rouge Area	Baton Rouge Area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 04:05:26 PM Eastern Daylight Time	08/03/2022 03:53:42 PM Eastern Daylight Time	07/30/2022 06:21:36 AM Eastern Daylight Time			08/04/2022 03:09:52 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	2023	Baton Rouge Area	Baton Rouge Area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 04:05:54 PM Eastern Daylight Time	08/03/2022 03:56:02 PM Eastern Daylight Time	07/30/2022 06:22:00 AM Eastern Daylight Time			08/04/2022 03:09:52 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	2023	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/02/2022	2023.01	08/02/2022 11:48:34 AM Eastern Daylight Time	08/03/2022 03:57:55 PM Eastern Daylight Time	07/30/2022 06:22:26 AM Eastern Daylight Time			08/04/2022 03:09:52 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	2023	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 04:06:28 PM Eastern Daylight Time	08/03/2022 03:58:22 PM Eastern Daylight Time	07/30/2022 06:22:52 AM Eastern Daylight Time			08/04/2022 03:09:52 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	2023	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 04:06:52 PM Eastern Daylight Time	08/03/2022 04:00:41 PM Eastern Daylight Time	07/30/2022 06:23:16 AM Eastern Daylight Time			08/04/2022 03:09:52 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	2023	New Orleans Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:10:59 PM Eastern Daylight Time	08/03/2022 04:01:09 PM Eastern Daylight Time	07/30/2022 06:23:40 AM Eastern Daylight Time			08/04/2022 02:38:25 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	2023	Select Louisiana Parishes		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 03:43:51 PM Eastern Daylight Time	08/03/2022 04:02:03 PM Eastern Daylight Time	07/30/2022 06:24:06 AM Eastern Daylight Time			08/04/2022 02:22:41 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	2023	Baton Rouge Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 03:43:44 PM Eastern Daylight Time	08/03/2022 04:02:30 PM Eastern Daylight Time	07/30/2022 06:24:30 AM Eastern Daylight Time			08/04/2022 02:22:41 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	2023	Lafayette LA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2022	2023.01	08/01/2022 03:43:37 PM Eastern Daylight Time	08/03/2022 04:01:36 PM Eastern Daylight Time	07/30/2022 06:24:56 AM Eastern Daylight Time			08/04/2022 02:22:41 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	2023	Baton Rouge Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 03:43:17 PM Eastern Daylight Time	08/03/2022 04:04:21 PM Eastern Daylight Time	07/30/2022 06:25:20 AM Eastern Daylight Time			08/04/2022 02:22:41 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	2023	LA Statewide		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	057	0	1	01	01	H1951_057_0	4	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 04:07:06 PM Eastern Daylight Time	08/03/2022 04:06:39 PM Eastern Daylight Time	07/30/2022 06:25:46 AM Eastern Daylight Time			08/04/2022 03:09:52 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-057 (HMO D-SNP)	01	01		1			H1951	057	0	2023	Louisiana		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/27/2022	2023.01	05/27/2022 04:10:31 PM Eastern Daylight Time					05/27/2022 04:18:26 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1951	801	0	2023	Select parishes in Louisiana		1	95876	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 04:12:19 PM Eastern Daylight Time					05/27/2022 04:18:26 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1951	804	0	2023	Select parishes in Louisiana		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/27/2022	2023.01	05/27/2022 04:15:19 PM Eastern Daylight Time					05/27/2022 04:18:26 PM 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	2023	Select parishes in Louisiana		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 04:18:09 PM Eastern Daylight Time					05/27/2022 04:18:26 PM 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	2023	Select parishes in Louisiana		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	02	01	H1961_003_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 02:33:00 PM Central Daylight Time	08/03/2022 10:38:24 AM Central Daylight Time	07/31/2022 01:01:06 AM Central Daylight Time			08/04/2022 03:50:08 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Health (HMO-POS D-SNP)	01	02		1			H1961	003	0	2023	South Louisiana		2		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	02	01	H1961_014_1	3	1			2		1	08/02/2022	2023.01	08/02/2022 03:34:16 PM Central Daylight Time	08/03/2022 10:38:55 AM Central Daylight Time	07/31/2022 01:01:31 AM Central Daylight Time			08/04/2022 03:50:08 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 (HMO-POS)	01	02		1			H1961	014	1	2023	New Orleans Metro Area and Northshore	Greater New Orleans and Baton Rouge area	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	2			
H1961	014	2	1	02	01	H1961_014_2	3	1			2		1	08/02/2022	2023.01	08/02/2022 03:34:32 PM Central Daylight Time	08/03/2022 10:39:28 AM Central Daylight Time	07/31/2022 01:01:55 AM Central Daylight Time			08/04/2022 03:50:08 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 (HMO-POS)	01	02		1			H1961	014	2	2023	New Orleans Metro Area and Northshore	Northshore	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	2			
H1961	014	3	1	02	01	H1961_014_3	3	1			2		1	08/02/2022	2023.01	08/02/2022 03:35:08 PM Central Daylight Time	08/03/2022 10:40:00 AM Central Daylight Time	07/31/2022 01:02:19 AM Central Daylight Time			08/04/2022 03:50:08 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 (HMO-POS)	01	02		1			H1961	014	3	2023	New Orleans Metro Area and Northshore	Southland	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	2			
H1961	014	4	1	02	01	H1961_014_4	4	1			2		1	08/02/2022	2023.01	08/02/2022 03:35:29 PM Central Daylight Time	08/03/2022 10:40:32 AM Central Daylight Time	07/31/2022 01:02:44 AM Central Daylight Time			08/04/2022 03:50:08 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 (HMO-POS)	01	02		1			H1961	014	4	2023	New Orleans Metro Area and Northshore	Rural Southeast	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	2			
H1961	017	0	1	02	01	H1961_017_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 03:35:51 PM Central Daylight Time	08/03/2022 10:41:04 AM Central Daylight Time	07/31/2022 01:03:08 AM Central Daylight Time			08/04/2022 03:50:08 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Gold (HMO-POS)	01	02		1			H1961	017	0	2023	Southwest and North 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	2			
H1961	019	0	1	02	01	H1961_019_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 02:34:37 PM Central Daylight Time	08/03/2022 10:41:36 AM Central Daylight Time	07/31/2022 01:03:32 AM Central Daylight Time			08/04/2022 03:50:08 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Complete (HMO-POS D-SNP)	01	02		1			H1961	019	0	2023	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						06/04/2022	2023.01	06/04/2022 10:31:42 AM Central Daylight Time					06/04/2022 10:33:34 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	801	0	2023	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						06/04/2022	2023.01	06/04/2022 10:31:53 AM Central Daylight Time					06/04/2022 10:33:34 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	802	0	2023	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						06/04/2022	2023.01	06/04/2022 10:32:06 AM Central Daylight Time					06/04/2022 10:33:34 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	803	0	2023	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						06/04/2022	2023.01	06/04/2022 10:32:20 AM Central Daylight Time					06/04/2022 10:33:34 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	804	0	2023	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	8	1					1	08/04/2022	2023.01	08/04/2022 12:14:21 PM Pacific Daylight Time	08/04/2022 02:28:50 PM Pacific Daylight Time	08/01/2022 01:36:44 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Ada and Canyon Counties		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2					2	2			
H1969	006	0	1	01	01	H1969_006_0	6	1				0	0	07/06/2022	2023.01	07/06/2022 12:42:43 PM Pacific Daylight Time	06/01/2022 05:16:32 PM Pacific Daylight Time				07/11/2022 09:05:44 AM 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	2023	Select Counties in Idaho		2		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)-		(800)735-2900		(711)-										2					2					2	2			
H1969	007	3	1	01	01	H1969_007_3	9	1					1	08/04/2022	2023.01	08/04/2022 12:00:21 PM Pacific Daylight Time	08/04/2022 02:29:28 PM Pacific Daylight Time	08/01/2022 01:37:59 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Idaho	Select Counties in Idaho	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2					2	2			
H1969	007	4	1	01	01	H1969_007_4	9	1					1	08/04/2022	2023.01	08/04/2022 12:08:26 PM Pacific Daylight Time	08/04/2022 02:30:07 PM Pacific Daylight Time	08/01/2022 01:39:12 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Idaho	Select Counties in Idaho	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2					2	2			
H1977	001	0	1	48	05	H1977_001_0	5	1						05/25/2023	2023.01	05/25/2023 03:50:06 PM Eastern Daylight Time					05/26/2023 07:51:50 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	2023	Upper Peninsula of Michigan		2	54000	2			2									http://www.uphp.com/medicare	http://www.uphp.com/medicare	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)-																
H1980	001	0	1	20	08	H1980_001_0	1	1						06/06/2022	2023.01	06/06/2022 02:08:36 PM Eastern Daylight Time		06/06/2022 02:11:20 PM Eastern Daylight Time			06/06/2022 02:13:38 PM Eastern Daylight Time	HOSPICE OF THE BLUEGRASS, INC	Bluegrass PACE Care	www.bgcarenav.org	Hospice of the Bluegrass, Inc. (PACE)	08	20		1			H1980	001	0	2023	Counties: Fayette, Woodfrd, Andersn, Frkln, Jess		2		2			2									bgcarenav.org	bgcarenav.org												(855)492-0812				(855)492-0812												(800)537-7697				(800)537-7697																
H1980	002	0	1	20	08	H1980_002_0	1	1						06/06/2022	2023.01	06/06/2022 02:08:53 PM Eastern Daylight Time		06/06/2022 02:11:20 PM Eastern Daylight Time			06/06/2022 02:13:38 PM Eastern Daylight Time	HOSPICE OF THE BLUEGRASS, INC	Bluegrass PACE Care	www.bgcarenav.org	Hospice of the Bluegrass, Inc. (PACE)	08	20		1			H1980	002	0	2023	Counties: Fayette, Woodfrd, Andersn, Frkln, Jess		2		2			2									bgcarenav.org	bgcarenav.org												(855)492-0812				(855)492-0812												(800)537-7697				(800)537-7697																
H1993	001	0	1	01	01	H1993_001_0	11	1					1	08/04/2022	2023.01	08/04/2022 02:17:45 PM Pacific Daylight Time	08/03/2022 04:22:19 PM Pacific Daylight Time	08/01/2022 10:00:18 AM Pacific Daylight Time			08/04/2022 02:20:12 PM Pacific Daylight Time	ASTIVA HEALTH, INC.	Astiva Health	https://astivahealth.com/	Astiva Health Savings Plan (HMO)	01	01		1			H1993	001	0	2023	Orange & 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	003	0	1	01	01	H1993_003_0	11	1					1	08/04/2022	2023.01	08/04/2022 11:21:47 AM Pacific Daylight Time	08/03/2022 04:23:00 PM Pacific Daylight Time	08/01/2022 10:02:12 AM Pacific Daylight Time			08/04/2022 02:20:12 PM Pacific Daylight Time	ASTIVA HEALTH, INC.	Astiva Health	https://astivahealth.com/	Astiva Health Classic Plan (HMO)	01	01		1			H1993	003	0	2023	Orange & 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	007	0	1	01	01	H1993_007_0	11	1		1			1	08/04/2022	2023.01	08/04/2022 11:18:17 AM Pacific Daylight Time	08/03/2022 04:23:46 PM Pacific Daylight Time	08/01/2022 10:04:16 AM Pacific Daylight Time			08/04/2022 02:20:12 PM Pacific Daylight Time	ASTIVA HEALTH, INC.	Astiva Health	https://astivahealth.com/	Astiva Health C-SNP Savings (HMO C-SNP)	01	01		1			H1993	007	0	2023	San Diego and Orange County		2		2			1	4			00011010000000000000000					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	008	0	1	01	01	H1993_008_0	11	1		1			1	08/04/2022	2023.01	08/04/2022 11:21:24 AM Pacific Daylight Time	08/03/2022 04:24:33 PM Pacific Daylight Time	08/01/2022 10:06:30 AM Pacific Daylight Time			08/04/2022 02:20:12 PM Pacific Daylight Time	ASTIVA HEALTH, INC.	Astiva Health	https://astivahealth.com/	Astiva Health C-SNP Premium (HMO C-SNP)	01	01		1			H1993	008	0	2023	San Diego and Orange County		2		2			1	4			00011010000000000000000					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	9	1					1	08/04/2022	2023.01	08/04/2022 10:06:59 PM Mountain Daylight Time	08/05/2022 10:55:53 AM Mountain Daylight Time	08/05/2022 10:55:53 AM Mountain Daylight Time			08/05/2022 11:27:24 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Essential (HMO)	01	01		1			H1994	001	0	2023	Northern Utah		2		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	14	1					1	08/10/2022	2023.01	08/10/2022 08:53:59 AM Mountain Daylight Time	08/05/2022 10:55:53 AM Mountain Daylight Time	08/05/2022 10:55:53 AM Mountain Daylight Time			08/10/2022 08:56:24 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Classic (HMO)	01	01		1			H1994	002	0	2023	Southwest and Central Utah		2		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	8	1					1	08/04/2022	2023.01	08/04/2022 09:49:09 PM Mountain Daylight Time	08/05/2022 10:55:53 AM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time			08/05/2022 11:27:24 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Essential (HMO)	01	01		1			H1994	003	0	2023	Ada, Boise, and Canyon Counties		2		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	004	0	1	01	01	H1994_004_0	8	1					1	07/12/2022	2023.01	07/12/2022 01:50:39 PM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time			08/05/2022 11:27:24 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Classic (HMO)	01	01		1			H1994	004	0	2023	Twin Falls County		2		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	08/04/2022	2023.01	08/04/2022 10:21:36 PM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time			08/05/2022 10:58:45 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Enhanced (HMO)	01	01		1			H1994	007	0	2023	Northern Utah		2		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	9	1					1	08/04/2022	2023.01	08/04/2022 09:52:58 PM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time			08/05/2022 11:27:24 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Enhanced (HMO)	01	01		1			H1994	008	0	2023	Ada, Boise, and Canyon Counties		2		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	012	0	1	01	01	H1994_012_0	9	1					1	08/04/2022	2023.01	08/04/2022 01:39:59 PM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time			08/05/2022 11:27:24 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Essential (HMO)	01	01		1			H1994	012	0	2023	Clark and Nye Counties		2		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	8	1					1	08/04/2022	2023.01	08/04/2022 01:55:35 PM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time			08/05/2022 11:27:24 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Classic (HMO)	01	01		1			H1994	013	0	2023	Southwest Idaho		2		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	014	0	1	01	01	H1994_014_0	9	1					1	09/13/2022	2023.01	09/13/2022 12:02:51 PM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time			09/16/2022 11:35:06 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Classic (HMO)	01	01		1			H1994	014	0	2023	Cassia, Gooding, Jerome, and Minidoka Counties		2		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	015	0	1	01	01	H1994_015_0	9	1	2	1			0	08/04/2022	2023.01	08/04/2022 09:24:30 PM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time			08/05/2022 11:27:24 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Dual (HMO D-SNP)	01	01		1			H1994	015	0	2023	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	6	1				0	0	07/21/2022	2023.01		07/27/2022 03:34:12 PM Mountain Daylight Time				07/27/2022 04:22:49 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare NoRx (HMO)	01	01		1			H1994	016	0	2023	Davis, Salt Lake, Utah, and Weber Counties		2		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	017	0	1	01	01	H1994_017_0	9	1					1	08/04/2022	2023.01	08/04/2022 09:42:46 PM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time	08/05/2022 10:55:54 AM Mountain Daylight Time			08/05/2022 11:27:24 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare Essential (HMO)	01	01		1			H1994	017	0	2023	Iron and Washington Counties		2		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		(855)442-9900		(801)442-9900		(855)442-9940		(801)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2	2			
H1994	801	0	1	01	01	H1994_801_0	4	1						06/06/2022	2023.01	06/06/2022 09:45:04 AM Mountain Daylight Time					06/06/2022 10:17:38 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare EGWP (HMO)	01	01		1			H1994	801	0	2023	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	06/06/2022	2023.01	06/06/2022 09:45:33 AM Mountain Daylight Time					06/06/2022 10:17:38 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare EGWP No Rx (HMO)	01	01		1			H1994	802	0	2023	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						06/06/2022	2023.01	06/06/2022 09:46:18 AM Mountain Daylight Time					06/06/2022 10:17:38 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Medicare EGWP Plan Year (HMO)	01	01		1			H1994	803	0	2023	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	8	1					1	08/04/2022	2023.01	08/04/2022 02:22:43 PM Eastern Daylight Time	08/04/2022 02:30:46 PM Pacific Daylight Time	08/01/2022 01:40:24 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO Plus (HMO)	01	01		1			H1997	002	0	2023	Select Counties in Washington		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2					2	2			
H1997	008	0	1	01	01	H1997_008_0	6	1				0	0	07/06/2022	2023.01	07/06/2022 12:44:04 PM Pacific Daylight Time	06/01/2022 05:19:09 PM Pacific Daylight Time				07/11/2022 09:05:44 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence Valiance (HMO)	01	01		1			H1997	008	0	2023	Select Counties in Washington		2		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)-		(800)735-2900		(711)-										2					2					2	2			
H1997	009	0	1	01	01	H1997_009_0	10	1					1	08/04/2022	2023.01	08/04/2022 02:28:44 PM Eastern Daylight Time	08/04/2022 02:31:24 PM Pacific Daylight Time	08/01/2022 01:41:37 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H1997	009	0	2023	Select Counties in Washington		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2					2	2			
H2001	001	0	1	04	01	H2001_001_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:30:59 AM Central Daylight Time	08/03/2022 10:32:53 AM Central Daylight Time	07/31/2022 01:03:56 AM Central Daylight Time			08/04/2022 02:21:09 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	2023	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	2	1					1	06/01/2022	2023.01	06/01/2022 09:07:57 PM Central Daylight Time	08/03/2022 10:33:43 AM Central Daylight Time	07/31/2022 01:04:20 AM Central Daylight Time			08/04/2022 02:21:09 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	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 10:36:53 AM Central Daylight Time	08/03/2022 10:34:34 AM Central Daylight Time	07/31/2022 01:04:44 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2001	017	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:31:27 AM Central Daylight Time	08/03/2022 10:35:26 AM Central Daylight Time	07/31/2022 01:05:08 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Northern Light Health Choice (PPO)	01	04		1			H2001	018	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:31:53 AM Central Daylight Time	08/03/2022 10:36:17 AM Central Daylight Time	07/31/2022 01:05:33 AM Central Daylight Time			08/04/2022 02:21:09 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	2023	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	1	1				0	0	05/30/2022	2023.01	05/30/2022 04:32:00 PM Central Daylight Time	06/01/2022 11:32:24 AM Central Daylight Time				06/02/2022 02:17:17 PM 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	2023	State of 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2001	023	0	1	04	01	H2001_023_0	3	1					1	08/04/2022	2023.01	08/04/2022 10:39:12 AM Central Daylight Time	08/03/2022 10:37:07 AM Central Daylight Time	07/31/2022 01:05:56 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2001	023	0	2023	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	816	0	1	04	01	H2001_816_0	1	1						06/03/2022	2023.01	06/03/2022 10:29:43 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	National Service Area		1	7927452	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1				0	0	06/03/2022	2023.01	06/03/2022 10:31:03 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	National Service Area		1	7715112	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	1	1						06/03/2022	2023.01	06/03/2022 10:31:23 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	National Service Area		1	2424	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 10:31:43 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	National Service Area		1	44676	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1				0	0	06/03/2022	2023.01	06/03/2022 10:32:06 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	National Service Area		1	98184	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	1	1						06/03/2022	2023.01	06/03/2022 10:32:26 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 10:34:03 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 10:34:26 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Select Counties		1	456	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	1	1						06/03/2022	2023.01	06/03/2022 10:34:53 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 10:35:24 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Select Counties		1	36456	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 10:35:45 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Select Counties		1	38172	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 10:37:06 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 10:39:20 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	829	0	1	04	01	H2001_829_0	1	1						06/03/2022	2023.01	06/03/2022 10:39:38 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	National Service Area		1	7044	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1				0	0	06/03/2022	2023.01	06/03/2022 10:39:58 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 10:40:16 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 10:40:32 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 10:42:43 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 10:43:00 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 10:43:17 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:11:48 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	94500	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 11:12:04 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	1291152	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 11:12:22 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	617136	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 11:13:06 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		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		(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	1	1				0	0	06/03/2022	2023.01	06/03/2022 11:13:29 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	59484	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	1	1						06/03/2022	2023.01	06/03/2022 11:13:45 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	96	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;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	1	1						06/03/2022	2023.01	06/03/2022 11:14:02 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:14:19 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	3132	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 11:14:41 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:27:39 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:31:05 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:31:33 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	1439256	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 11:31:50 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	9984	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1				0	0	06/03/2022	2023.01	06/03/2022 11:32:17 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 11:34:36 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 11:38:59 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 11:39:36 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:40:40 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	32376	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1				0	0	06/03/2022	2023.01	06/03/2022 11:52:32 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:53:08 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 11:53:45 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:54:14 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	112788	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 11:54:51 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	25812	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 11:55:20 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	63216	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1				0	0	06/03/2022	2023.01	06/03/2022 12:00:34 PM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	861	0	1	04	01	H2001_861_0	1	1						06/03/2022	2023.01	06/03/2022 12:00:51 PM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:56:41 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	Nationwide		1	278832	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1						06/03/2022	2023.01	06/03/2022 11:56:56 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:57:13 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:57:32 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:58:49 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 11:59:22 AM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 12:00:04 PM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 12:01:07 PM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 12:01:30 PM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 12:01:47 PM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 12:02:12 PM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 12:02:37 PM Eastern Daylight Time					06/03/2022 03:37:39 PM 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	2023	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	874	0	2	04	01	H2001_874_0	1	1						06/03/2022	2023.01	06/03/2022 12:03:05 PM Eastern Daylight Time					06/03/2022 03:37:39 PM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	874	0	2023	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	875	0	1	04	01	H2001_875_0	2	1						06/16/2022	2023.01	06/16/2022 03:02:59 PM Eastern Daylight Time					06/17/2022 11:12:35 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	875	0	2023	Nationwide		1	174000	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	876	0	2	04	01	H2001_876_0	1	1						06/03/2022	2023.01	06/03/2022 12:03:59 PM Eastern Daylight Time					06/03/2022 03:37:39 PM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	876	0	2023	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	877	0	1	04	01	H2001_877_0	1	1						06/03/2022	2023.01	06/03/2022 12:04:20 PM Eastern Daylight Time					06/03/2022 03:37:39 PM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	877	0	2023	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	878	0	1	04	01	H2001_878_0	1	1						06/03/2022	2023.01	06/03/2022 12:04:38 PM Eastern Daylight Time					06/03/2022 03:37:39 PM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	878	0	2023	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	879	0	1	04	01	H2001_879_0	1	1						06/03/2022	2023.01	06/03/2022 12:05:25 PM Eastern Daylight Time					06/03/2022 03:37:39 PM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	879	0	2023	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	880	0	1	04	01	H2001_880_0	1	1						06/03/2022	2023.01	06/03/2022 12:05:47 PM Eastern Daylight Time					06/03/2022 03:37:39 PM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	880	0	2023	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									
H2029	001	0	1	04	01	H2029_001_0	4	1					1	08/01/2022	2023.01	08/01/2022 01:02:37 PM Eastern Daylight Time	08/03/2022 03:40:13 PM Eastern Daylight Time	07/30/2022 06:26:10 AM Eastern Daylight Time			08/04/2022 02:02:59 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	2023	Puerto Rico Island Wide		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1						05/27/2022	2023.01	05/27/2022 12:02:05 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	801	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1				0	0	05/27/2022	2023.01	05/27/2022 12:03:13 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	802	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1						05/27/2022	2023.01	05/27/2022 12:03:50 PM Eastern Daylight Time					06/03/2022 09:12:09 AM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1				0	0	05/27/2022	2023.01	05/27/2022 12:04:24 PM Eastern Daylight Time					06/03/2022 09:12:09 AM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1						05/27/2022	2023.01	05/27/2022 12:04:58 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	809	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1				0	0	05/27/2022	2023.01	05/27/2022 12:05:32 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	810	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1						05/27/2022	2023.01	05/27/2022 12:06:35 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	811	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1				0	0	05/27/2022	2023.01	05/27/2022 12:07:16 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	812	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1						05/27/2022	2023.01	05/27/2022 12:07:51 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	813	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1				0	0	05/27/2022	2023.01	05/27/2022 12:09:02 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	814	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1						05/27/2022	2023.01	05/27/2022 12:09:21 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	815	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1				0	0	05/27/2022	2023.01	05/27/2022 12:09:42 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	816	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	817	0	1	04	01	H2029_817_0	5	1						06/02/2022	2023.01	06/02/2022 09:00:55 AM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	817	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	818	0	1	04	01	H2029_818_0	4	1				0	0	05/27/2022	2023.01	05/27/2022 12:10:28 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	818	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	819	0	1	04	01	H2029_819_0	4	1						05/31/2022	2023.01	05/31/2022 09:12:32 AM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	819	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	820	0	1	04	01	H2029_820_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 09:13:29 AM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	820	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	821	0	1	04	01	H2029_821_0	4	1						05/31/2022	2023.01	05/31/2022 09:14:05 AM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	821	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	822	0	1	04	01	H2029_822_0	4	1				0	0	05/27/2022	2023.01	05/27/2022 12:11:56 PM Eastern Daylight Time					06/03/2022 09:12:09 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	822	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	7	1					1	08/03/2022	2023.01	08/03/2022 02:39:25 PM Central Daylight Time	08/04/2022 09:16:16 AM Central Daylight Time	08/04/2022 09:16:37 AM Central Daylight Time			08/04/2022 09:20:16 AM Central Daylight Time	Baylor Scott & White Insurance Company	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage (PPO)	01	04		1			H2032	001	0	2023	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	6	1					1	08/03/2022	2023.01	08/03/2022 02:40:34 PM Central Daylight Time	08/04/2022 09:16:16 AM Central Daylight Time	08/04/2022 09:16:38 AM Central Daylight Time			08/04/2022 09:20:16 AM Central Daylight Time	Baylor Scott & White Insurance Company	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Basic (PPO)	01	04		1			H2032	002	0	2023	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	7	1					1	08/03/2022	2023.01	08/03/2022 02:41:11 PM Central Daylight Time	08/04/2022 09:16:16 AM Central Daylight Time	08/04/2022 09:16:38 AM Central Daylight Time			08/04/2022 09:20:16 AM Central Daylight Time	Baylor Scott & White Insurance Company	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Platinum (PPO)	01	04		1			H2032	003	0	2023	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						05/09/2022	2023.01	05/09/2022 08:04:33 AM Central Daylight Time					06/06/2022 10:38:42 PM Central Daylight Time	Baylor Scott & White Insurance Company	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP CY Rx (PPO)	01	04		1			H2032	801	0	2023	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	05/09/2022	2023.01	05/09/2022 08:07:58 AM Central Daylight Time					06/06/2022 10:38:42 PM Central Daylight Time	Baylor Scott & White Insurance Company	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP CY (PPO)	01	04		1			H2032	802	0	2023	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						05/09/2022	2023.01	05/09/2022 08:08:11 AM Central Daylight Time					06/06/2022 10:38:42 PM Central Daylight Time	Baylor Scott & White Insurance Company	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP FY Rx (PPO)	01	04		1			H2032	803	0	2023	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	05/09/2022	2023.01	05/09/2022 08:09:49 AM Central Daylight Time					06/06/2022 10:38:42 PM Central Daylight Time	Baylor Scott & White Insurance Company	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP FY (PPO)	01	04		1			H2032	804	0	2023	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	6	1	2	1			0	08/05/2022	2023.01	08/05/2022 09:19:58 AM Central Daylight Time	08/05/2022 10:07:11 AM Central Daylight Time	08/05/2022 10:07:12 AM Central Daylight Time			08/05/2022 10:08:23 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	2023	Eastern Wisconsin		2		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	4	1						08/10/2022	2023.01	08/10/2022 02:55:36 PM Eastern Daylight Time	08/02/2022 03:10:03 PM Eastern Daylight Time	07/31/2022 09:28:14 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 02:56:11 PM Eastern Daylight Time	08/02/2022 03:11:03 PM Eastern Daylight Time	07/31/2022 09:28:38 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 02:57:49 PM Eastern Daylight Time	08/02/2022 03:12:10 PM Eastern Daylight Time	07/31/2022 09:29:04 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 02:58:14 PM Eastern Daylight Time	08/02/2022 03:13:11 PM Eastern Daylight Time	07/31/2022 09:29:30 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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						08/10/2022	2023.01	08/10/2022 02:58:41 PM Eastern Daylight Time	08/02/2022 03:14:13 PM Eastern Daylight Time	07/31/2022 09:29:54 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	05/30/2022	2023.01	05/30/2022 10:03:41 AM Eastern Daylight Time					06/02/2022 02:59:22 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	2023	Idaho and Oregon		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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;7k;8a;14d;14e2;18a;	1					1				
H2056	802	0	1	01	01	H2056_802_0	1	1						05/30/2022	2023.01	05/30/2022 10:00:50 AM Eastern Daylight Time					06/02/2022 02:59:22 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	2023	Idaho and Oregon		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H2064	001	0	1	20	08	H2064_001_0	2	1						06/03/2022	2023.01	06/03/2022 02:37:26 PM Eastern Daylight Time		06/06/2022 11:34:27 AM Eastern Daylight Time			06/06/2022 11:36:22 AM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	001	0	2023	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						06/03/2022	2023.01	06/03/2022 02:37:47 PM Eastern Daylight Time		06/06/2022 11:34:27 AM Eastern Daylight Time			06/06/2022 11:36:22 AM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	002	0	2023	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																
H2085	001	0	1	20	08	H2085_001_0	1	1						10/14/2022	2023.01	10/14/2022 12:02:31 PM Pacific Daylight Time		10/14/2022 12:11:46 PM Pacific Daylight Time			10/14/2022 12:15:04 PM Pacific Daylight Time	COLLABRIA CARE	Providence PACE	collabriacare.org	Providence PACE - Napa (Dual Eligible) (PACE)	08	20		1			H2085	001	0	2023	Napa, Solano, Sonoma counties		2		2			2									collabriacare.org	collabriacare.org												(707)254-4169				(707)254-4169												(707)254-4169				(707)254-4169																
H2085	002	0	1	20	08	H2085_002_0	1	1						10/14/2022	2023.01	10/14/2022 12:03:10 PM Pacific Daylight Time		10/14/2022 12:11:46 PM Pacific Daylight Time			10/14/2022 12:15:04 PM Pacific Daylight Time	COLLABRIA CARE	Providence PACE	collabriacare.org	Providence PACE - Napa (Medicare Only) (PACE)	08	20		1			H2085	002	0	2023	Napa, Solano, Sonoma counties		2		2			2									collabriacare.org	collabriacare.org												(707)254-4169				(707)254-4169												(707)254-4169				(707)254-4169																
H2108	001	0	1	01	01	H2108_001_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 07:09:45 PM Central Daylight Time	08/02/2022 04:01:21 PM Central Daylight Time	08/01/2022 10:27:37 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H2108	001	0	2023	Baltimore/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	4	1			2		1	06/01/2022	2023.01	06/01/2022 07:09:36 PM Central Daylight Time	08/02/2022 04:02:29 PM Central Daylight Time	08/01/2022 10:28:08 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H2108	022	0	2023	Baltimore		2		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	028	0	1	01	01	H2108_028_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:13:30 PM Central Daylight Time	08/02/2022 04:03:15 PM Central Daylight Time	08/01/2022 10:28:40 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H2108	028	0	2023	Washington DC/Delaware		2		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	029	0	1	01	01	H2108_029_0	5	1		1				07/18/2022	2023.01	07/18/2022 02:24:52 PM Central Daylight Time	08/02/2022 04:04:59 PM Central Daylight Time	08/01/2022 10:29:11 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Achieve Medicare (HMO C-SNP)	01	01		1			H2108	029	0	2023	Washington DC/Delaware		2		2			1	4			00000010000000000000000					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	030	0	1	01	01	H2108_030_0	4	1		1				06/01/2022	2023.01	06/01/2022 07:09:10 PM Central Daylight Time	08/02/2022 04:05:57 PM Central Daylight Time	08/01/2022 10:29:42 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Achieve Medicare (HMO C-SNP)	01	01		1			H2108	030	0	2023	Baltimore		2		2			1	4			00000010000000000000000					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	036	0	1	01	01	H2108_036_0	4	1			2		1	06/01/2022	2023.01	06/01/2022 07:09:05 PM Central Daylight Time	08/02/2022 04:07:29 PM Central Daylight Time	08/01/2022 10:30:13 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Alliance Medicare (HMO)	01	01		1			H2108	036	0	2023	Baltimore		2		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	039	0	1	01	01	H2108_039_0	5	1	2	1	1		0	07/18/2022	2023.01	07/18/2022 02:20:16 PM Central Daylight Time	08/02/2022 04:08:53 PM Central Daylight Time	08/01/2022 10:30:45 AM Central Daylight Time			08/04/2022 01:55:36 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	2023	Delaware		2		2			1	3		1					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	801	0	1	01	01	H2108_801_0	2	1						05/22/2022	2023.01	05/22/2022 05:27:11 PM Central Daylight Time					06/02/2022 08:07:39 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H2108	801	0	2023	Statewide DE, MD and DC		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;	1					1				
H2109	001	0	1	20	08	H2109_001_0	1	1						05/26/2022	2023.01	05/26/2022 02:04:01 PM Eastern Daylight Time		05/26/2022 01:57:19 PM Eastern Daylight Time			05/26/2022 02:06:26 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	2023	Parts of Baltimore City and County, Maryland		2		2			2									http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus												(410)550-7044				(410)550-7044												(410)550-0316				(410)550-0316																
H2109	002	0	1	20	08	H2109_002_0	1	1						05/26/2022	2023.01	05/26/2022 02:04:23 PM Eastern Daylight Time		05/26/2022 01:57:19 PM Eastern Daylight Time			05/26/2022 02:06:26 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	2023	Parts of Baltimore City and County, Maryland		2		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	6	1			2			08/01/2022	2023.01	08/01/2022 02:13:18 PM Eastern Daylight Time	08/03/2022 07:50:06 PM Eastern Daylight Time	07/30/2022 08:39:42 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in MI		2		2			2									https://wellcare.mimeridian.com/findadoctor	https://wellcare.mimeridian.com/formulary	https://wellcare.mimeridian.com/findadoctor	(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			
H2117	002	0	1	04	01	H2117_002_0	7	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:05:28 AM Eastern Daylight Time	08/03/2022 07:51:23 PM Eastern Daylight Time	07/30/2022 08:40:15 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in MI		2		2			1	3		1					1	https://wellcare.mimeridian.com/findadoctor	https://wellcare.mimeridian.com/formulary	https://wellcare.mimeridian.com/findadoctor	(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			
H2117	003	0	1	04	01	H2117_003_0	5	1			2	0	0	07/14/2022	2023.01	07/14/2022 01:03:13 PM Eastern Daylight Time	06/03/2022 10:04:34 PM Eastern Daylight Time				07/15/2022 03:48:22 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	2023	Select counties in MI		2		2			2									https://wellcare.mimeridian.com/findadoctor	https://wellcare.mimeridian.com/formulary	https://wellcare.mimeridian.com/findadoctor	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2117	004	0	1	04	01	H2117_004_0	6	1			2			08/01/2022	2023.01	08/01/2022 02:23:04 PM Eastern Daylight Time	08/03/2022 07:52:34 PM Eastern Daylight Time	07/30/2022 08:40:47 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in MI		2		2			2									https://wellcare.mimeridian.com/findadoctor	https://wellcare.mimeridian.com/formulary	https://wellcare.mimeridian.com/findadoctor	(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			
H2128	001	0	1	04	01	H2128_001_0	4	1						07/14/2022	2023.01	07/14/2022 09:11:07 AM Eastern Daylight Time	08/03/2022 07:39:48 PM Eastern Daylight Time	07/30/2022 08:41:19 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	CELTIC INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellPA	Wellcare Assist Open (PPO)	01	04		1			H2128	001	0	2023	Select Counties in PA		2		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						08/01/2022	2023.01	08/01/2022 04:08:29 PM Eastern Daylight Time	08/03/2022 07:40:56 PM Eastern Daylight Time	07/30/2022 08:41:50 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	CELTIC INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellPA	Wellcare No Premium Open (PPO)	01	04		1			H2128	002	0	2023	Select Counties in PA		2		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						08/01/2022	2023.01	08/01/2022 04:16:21 PM Eastern Daylight Time	08/03/2022 07:42:02 PM Eastern Daylight Time	07/30/2022 08:42:22 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	CELTIC INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellPA	Wellcare Low Premium Open (PPO)	01	04		1			H2128	003	0	2023	Select Counties in PA		2		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						05/30/2022	2023.01	05/30/2022 10:42:18 AM Eastern Daylight Time	08/03/2022 07:47:12 PM Eastern Daylight Time	07/30/2022 08:42:54 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	CELTIC INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellPA	Wellcare Giveback Open (PPO)	01	04		1			H2128	004	0	2023	Select Counties in PA		2		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	005	0	1	04	01	H2128_005_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 02:31:50 PM Eastern Daylight Time	08/03/2022 07:48:23 PM Eastern Daylight Time	07/30/2022 08:43:26 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	CELTIC INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellPA	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H2128	005	0	2023	Select counties in PA		2		2			1	3		1					1	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(866)330-9368		(866)330-9368		(844)917-0175		(844)917-0175		(866)330-9368		(866)330-9368		(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	6	1	2	1	1		0	07/14/2022	2023.01	07/14/2022 01:56:31 PM Eastern Daylight Time	08/03/2022 08:18:43 PM Eastern Daylight Time	07/30/2022 08:43:58 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in NM		2		2			1	3		1					1	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(844)810-7965		(844)810-7965		(844)917-0175		(844)917-0175		(844)810-7965		(844)810-7965		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	002	0	1	01	01	H2134_002_0	4	1			2			06/02/2022	2023.01	06/02/2022 01:52:33 PM Eastern Daylight Time	08/03/2022 08:20:11 PM Eastern Daylight Time	07/30/2022 08:44:30 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in NM		2		2			2									www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	003	0	1	01	01	H2134_003_0	7	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:25:28 AM Eastern Daylight Time	08/03/2022 08:21:41 PM Eastern Daylight Time	07/30/2022 08:45:02 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in NM		2		2			1	3		1					1	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(844)810-7965		(844)810-7965		(844)917-0175		(844)917-0175		(844)810-7965		(844)810-7965		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	004	0	1	01	01	H2134_004_0	4	1			2			05/26/2022	2023.01	05/26/2022 12:04:26 PM Eastern Daylight Time	08/03/2022 08:23:24 PM Eastern Daylight Time	07/30/2022 08:45:44 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in NM		2		2			2									www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	005	0	1	01	01	H2134_005_0	4	1			2			08/02/2022	2023.01	08/02/2022 10:09:37 AM Eastern Daylight Time	08/03/2022 08:25:28 PM Eastern Daylight Time	07/30/2022 08:46:25 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in NM		2		2			2									www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	006	0	1	01	01	H2134_006_0	4	1			2	0	0	05/26/2022	2023.01	05/26/2022 12:08:27 PM Eastern Daylight Time	06/03/2022 08:58:53 PM Central Daylight Time				07/15/2022 04:24:29 PM Central 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	2023	Select counties in NM		2		2			2									www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2134	801	0	1	01	01	H2134_801_0	1	1						05/10/2022	2023.01	05/10/2022 09:52:02 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	01	01		1			H2134	801	0	2023	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	1	1				0	0	05/10/2022	2023.01	05/10/2022 09:52:08 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	01	01		1			H2134	802	0	2023	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	1	1						05/10/2022	2023.01	05/10/2022 09:52:13 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	01	01		1			H2134	803	0	2023	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				
H2162	001	0	1	01	01	H2162_001_0	4	1						08/01/2022	2023.01	08/01/2022 02:08:41 PM Eastern Daylight Time	08/03/2022 08:43:47 PM Eastern Daylight Time	07/30/2022 08:47:04 AM Eastern Daylight Time			08/04/2022 05:27:00 PM Eastern Daylight Time	WELLCARE OF NEW HAMPSHIRE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H2162	001	0	2023	Select counties in NH		2		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	6	1	2	1			0	09/29/2022	2023.01	09/29/2022 11:36:15 AM Eastern Daylight Time	08/03/2022 03:32:16 PM Eastern Daylight Time	08/03/2022 04:03:09 PM Eastern Daylight Time			09/29/2022 11:37:42 AM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX	www.villagecaremax.org	VillageCareMAX Medicare Health Advantage (HMO D-SNP)	01	01		1			H2168	001	0	2023	New York City boroughs, Nassau & Westchester		2		2			1	3		2					1	www.villagecaremax.org	www.villagecaremax.org	www.villagecaremax.org	(800)469-6292		(800)469-6292		(800)469-6292		(800)469-6292		(888)807-6806		(888)807-6806		(800)469-6292		(800)469-6292		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2168	002	0	1	01	01	H2168_002_0	6	1	2	1			0	09/29/2022	2023.01	09/29/2022 11:36:33 AM Eastern Daylight Time	08/03/2022 03:33:57 PM Eastern Daylight Time	08/03/2022 03:52:09 PM Eastern Daylight Time			09/29/2022 11:37:42 AM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX	www.villagecaremax.org	VillageCareMAX Medicare Total Advantage (HMO D-SNP)	01	01		1			H2168	002	0	2023	New York City boroughs, Nassau & Westchester		2		2			1	3		1					1	www.villagecaremax.org	www.villagecaremax.org	www.villagecaremax.org	(800)469-6292		(800)469-6292		(800)469-6292		(800)469-6292		(888)807-6806		(888)807-6806		(800)469-6292		(800)469-6292		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2168	003	0	1	01	01	H2168_003_0	6	1	2	1			0	09/29/2022	2023.01	09/29/2022 11:36:56 AM Eastern Daylight Time	08/03/2022 03:46:47 PM Eastern Daylight Time	08/03/2022 04:05:03 PM Eastern Daylight Time			09/29/2022 11:37:42 AM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX	www.villagecaremax.org	VillageCareMAX Medicare Health Advantage FLEX (HMO D-SNP)	01	01		1			H2168	003	0	2023	New York City boroughs, Nassau & Westchester		2		2			1	3		2					1	www.villagecaremax.org	www.villagecaremax.org	www.villagecaremax.org	(800)469-6292		(800)469-6292		(800)469-6292		(800)469-6292		(888)807-6806		(888)807-6806		(800)469-6292		(800)469-6292		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2171	001	0	1	01	01	H2171_001_0	5	1					1	08/03/2022	2023.01	08/03/2022 11:23:35 AM Mountain Daylight Time	08/04/2022 10:30:36 AM Mountain Daylight Time	08/02/2022 07:03:47 PM Mountain Daylight Time			08/04/2022 01:20:40 PM Mountain 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	2023	Dallas Fort Worth Metro Area		2		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	5	1					1	08/03/2022	2023.01	08/03/2022 11:23:47 AM Mountain Daylight Time	08/04/2022 10:31:14 AM Mountain Daylight Time	08/02/2022 07:04:22 PM Mountain Daylight Time			08/04/2022 01:20:40 PM Mountain 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	2023	Dallas Fort Worth Metro Area		2		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	4	1						06/29/2022	2023.01	06/29/2022 10:48:28 AM Mountain Daylight Time					07/11/2022 12:36:56 PM Mountain 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	2023	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	4	1						06/29/2022	2023.01	06/29/2022 10:48:46 AM Mountain Daylight Time					07/11/2022 12:36:56 PM Mountain 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	2023	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	4	1				0	0	06/29/2022	2023.01	06/29/2022 10:51:54 AM Mountain Daylight Time					07/11/2022 12:36:56 PM Mountain 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	2023	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	4	1				0	0	06/29/2022	2023.01	06/29/2022 10:51:45 AM Mountain Daylight Time					07/11/2022 12:36:56 PM Mountain 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	2023	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	02	01	H2172_001_0	8	1						08/01/2022	2023.01	08/01/2022 07:44:28 PM Eastern Daylight Time	08/03/2022 09:21:22 PM Eastern Daylight Time	08/03/2022 09:32:30 PM Eastern Daylight Time			08/05/2022 11:12:36 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage High DC (HMO-POS)	01	02		1			H2172	001	0	2023	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	02	01	H2172_002_0	7	1						08/01/2022	2023.01	08/01/2022 07:44:40 PM Eastern Daylight Time	08/03/2022 09:21:49 PM Eastern Daylight Time	08/03/2022 09:33:20 PM Eastern Daylight Time			08/05/2022 11:12:36 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage High MD (HMO-POS)	01	02		1			H2172	002	0	2023	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	02	01	H2172_003_0	7	1						07/28/2022	2023.01	07/28/2022 03:18:25 PM Eastern Daylight Time	08/03/2022 09:22:16 PM Eastern Daylight Time	08/03/2022 09:34:10 PM Eastern Daylight Time			08/05/2022 11:12:36 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Standard DC (HMO-POS)	01	02		1			H2172	003	0	2023	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	02	01	H2172_004_0	7	1						07/28/2022	2023.01	07/28/2022 03:18:39 PM Eastern Daylight Time	08/03/2022 09:22:43 PM Eastern Daylight Time	08/03/2022 09:35:00 PM Eastern Daylight Time			08/05/2022 11:12:36 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Standard MD (HMO-POS)	01	02		1			H2172	004	0	2023	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	5	1				0	0	07/08/2022	2023.01	07/08/2022 10:54:27 AM Eastern Daylight Time	06/06/2022 10:01:17 AM Eastern Daylight Time				07/15/2022 11:07:44 AM 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	2023	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	6	1						08/01/2022	2023.01	08/01/2022 07:45:52 PM Eastern Daylight Time	08/03/2022 09:23:38 PM Eastern Daylight Time	08/03/2022 09:35:49 PM Eastern Daylight Time			08/05/2022 11:12:36 AM 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	2023	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	02	01	H2172_008_0	7	1						08/01/2022	2023.01	08/01/2022 07:44:58 PM Eastern Daylight Time	08/03/2022 09:24:06 PM Eastern Daylight Time	08/03/2022 09:36:37 PM Eastern Daylight Time			08/05/2022 11:12:36 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage High VA (HMO-POS)	01	02		1			H2172	008	0	2023	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	02	01	H2172_009_0	6	1						07/12/2022	2023.01	07/12/2022 09:14:28 AM Eastern Daylight Time	08/05/2022 06:54:08 AM Eastern Daylight Time	08/04/2022 06:46:56 PM Eastern Daylight Time			08/05/2022 11:12:36 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Standard VA (HMO-POS)	01	02		1			H2172	009	0	2023	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	02	01	H2172_010_0	6	1						08/01/2022	2023.01	08/01/2022 07:43:50 PM Eastern Daylight Time	08/03/2022 09:25:09 PM Eastern Daylight Time	08/03/2022 09:38:34 PM Eastern Daylight Time			08/05/2022 11:12:36 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Value VA (HMO-POS)	01	02		1			H2172	010	0	2023	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	6	1						08/01/2022	2023.01	08/01/2022 07:42:09 PM Eastern Daylight Time	08/03/2022 09:25:37 PM Eastern Daylight Time	08/03/2022 09:39:23 PM Eastern Daylight Time			08/05/2022 11:12:36 AM 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	2023	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	02	01	H2172_012_0	6	1						08/01/2022	2023.01	08/01/2022 07:52:42 PM Eastern Daylight Time	08/03/2022 09:26:06 PM Eastern Daylight Time	08/03/2022 09:40:15 PM Eastern Daylight Time			08/05/2022 11:12:36 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Value DC (HMO-POS)	01	02		1			H2172	012	0	2023	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	013	0	1	02	01	H2172_013_0	6	1						07/08/2022	2023.01	07/08/2022 10:59:00 AM Eastern Daylight Time	08/05/2022 06:53:09 AM Eastern Daylight Time	08/03/2022 09:41:04 PM Eastern Daylight Time			08/05/2022 11:12:36 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Care Plus (HMO-POS)	01	02		1			H2172	013	0	2023	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	801	0	1	01	01	H2172_801_0	4	1						05/27/2022	2023.01	05/27/2022 10:14:07 AM Eastern Daylight Time					06/06/2022 10:54:57 AM 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	2023	DC, MD, VA		1	175845	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						06/01/2022	2023.01	06/01/2022 08:48:03 AM Eastern Daylight Time					06/06/2022 10:54:57 AM 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	2023	DC, MD, VA		1	146377	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						05/27/2022	2023.01	05/27/2022 10:14:35 AM Eastern Daylight Time					06/06/2022 10:54:57 AM 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	2023	DC, MD, VA		1	862	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	05/27/2022	2023.01	05/27/2022 10:15:07 AM Eastern Daylight Time					06/06/2022 10:54:57 AM 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	2023	DC, MD, VA		1	136	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	6	1	2	1	1		0	07/19/2022	2023.01	07/19/2022 11:21:37 AM Eastern Daylight Time	08/03/2022 07:31:44 PM Eastern Daylight Time	07/30/2022 08:47:37 AM Eastern Daylight Time			08/04/2022 05:06:33 PM Eastern Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Wellcare by Trillium	www.wellcare.com/trilliumOR	Wellcare Dual Select (HMO D-SNP)	01	01		1			H2174	001	0	2023	Select counties in OR		2		2			1	3		2					2	www.wellcare.com/trilliumOR	www.wellcare.com/trilliumOR	www.wellcare.com/trilliumOR	(844)867-1156		(844)867-1156		(844)917-0175		(844)917-0175		(844)867-1156		(844)867-1156		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2185	001	0	1	01	01	H2185_001_0	5	1		1				08/09/2022	2023.01	08/09/2022 12:27:33 PM Central Daylight Time	08/03/2022 11:35:49 AM Central Daylight Time	08/02/2022 11:04:26 AM Central Daylight Time			08/09/2022 12:53:11 PM Central Daylight Time	LIFEWORKS ADVANTAGE, LLC	LifeWorks Advantage	www.lifeworksadvantage.com	LifeWorks Advantage I-SNP (HMO I-SNP)	01	01		1			H2185	001	0	2023	Virginia (partial)		2		2			1	1	3							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			
H2185	003	0	1	01	01	H2185_003_0	8	1		1				08/02/2022	2023.01	08/02/2022 08:48:46 PM Central Daylight Time	08/03/2022 04:56:00 PM Central Daylight Time	08/11/2022 09:27:22 AM Central Daylight Time			08/11/2022 03:11:50 PM Central Daylight Time	LIFEWORKS ADVANTAGE, LLC	LifeWorks Advantage	www.lifeworksadvantage.com	LifeWorks Advantage IE-SNP (HMO I-SNP)	01	01		1			H2185	003	0	2023	Virginia (partial)		2		2			1	1	3							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	02	01	H2196_001_0	2	1					1	08/02/2022	2023.01	08/02/2022 03:38:41 PM Central Daylight Time	08/03/2022 11:12:17 AM Central Daylight Time	07/31/2022 01:06:20 AM Central Daylight Time			08/04/2022 04:00:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2196	001	0	2023	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			
H2218	001	0	1	20	08	H2218_001_0	1	1						06/03/2022	2023.01	06/03/2022 12:14:59 PM Eastern Daylight Time		06/03/2022 11:58:00 AM Eastern Daylight Time			06/03/2022 12:17:25 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	2023	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						06/03/2022	2023.01	06/03/2022 12:15:29 PM Eastern Daylight Time		06/03/2022 11:58:00 AM Eastern Daylight Time			06/03/2022 12:17:25 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	2023	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						06/01/2022	2023.01	06/01/2022 12:24:56 PM Eastern Daylight Time		06/01/2022 12:42:49 PM Eastern Daylight Time			06/01/2022 01:45:36 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	2023	In all MA counties except BAR, DUK, NAN and SUF		2		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						06/01/2022	2023.01	06/01/2022 08:31:51 AM Eastern Daylight Time		06/01/2022 12:42:47 PM Eastern Daylight Time			06/01/2022 01:45:36 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	2023	In all MA counties except BAR, DUK, NAN and SUF		2		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	2	1						07/27/2022	2023.01	07/27/2022 02:54:58 PM Eastern Daylight Time		07/27/2022 02:57:19 PM Eastern Daylight Time			07/27/2022 03:00:16 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	2023	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	2	1						07/27/2022	2023.01	07/27/2022 02:55:17 PM Eastern Daylight Time		07/27/2022 02:57:28 PM Eastern Daylight Time			07/27/2022 03:00:16 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	2023	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						06/01/2022	2023.01	06/01/2022 06:58:17 AM Eastern Daylight Time		05/31/2022 08:56:30 AM Eastern Daylight Time			06/01/2022 07:01:42 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	2023	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						06/01/2022	2023.01	06/01/2022 06:59:02 AM Eastern Daylight Time		05/31/2022 08:56:47 AM Eastern Daylight Time			06/01/2022 07:01:42 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	2023	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						06/01/2022	2023.01	06/01/2022 08:15:31 AM Eastern Daylight Time		06/01/2022 07:59:49 AM Eastern Daylight Time			06/01/2022 08:16:45 AM Eastern Daylight Time	ELEMENT CARE, INC.	Element Care, Inc	www.elementcare.org	Element Care (PACE)	08	20		1			H2222	002	0	2023	Essex, Middlesex counties		2	11736	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						06/01/2022	2023.01	06/01/2022 08:15:59 AM Eastern Daylight Time		06/01/2022 07:59:49 AM Eastern Daylight Time			06/01/2022 08:16:45 AM Eastern Daylight Time	ELEMENT CARE, INC.	Element Care, Inc	www.elementcare.org	Element Care (PACE)	08	20		1			H2222	003	0	2023	Essex, Middlesex counties		2	11736	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						06/05/2022	2023.01	06/05/2022 08:32:44 AM Eastern Daylight Time		06/01/2022 08:22:18 AM Eastern Daylight Time			06/05/2022 08:38:25 AM Eastern Daylight Time	East Boston Neighborhood Center Corp.	Neighborhood PACE	www.ebnhc.org/elderservice.php	Neighborhood PACE (PACE)	08	20		1			H2223	001	0	2023	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						06/05/2022	2023.01	06/05/2022 08:33:18 AM Eastern Daylight Time		06/01/2022 08:22:19 AM Eastern Daylight Time			06/05/2022 08:38:25 AM Eastern Daylight Time	East Boston Neighborhood Center Corp.	Neighborhood PACE	www.ebnhc.org/elderservice.php	Neighborhood PACE (PACE)	08	20		1			H2223	002	0	2023	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	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:45:08 PM Pacific Daylight Time	08/04/2022 05:56:06 PM Pacific Daylight Time	08/01/2022 10:28:18 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.molinahealthcare.com/medicare	Senior Whole Health (HMO D-SNP)	01	01		1			H2224	001	0	2023	Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor		2		2			1	3		1					1	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(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	9	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:45:20 PM Pacific Daylight Time	08/04/2022 05:56:34 PM Pacific Daylight Time	08/01/2022 10:28:50 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.molinahealthcare.com/medicare	Senior Whole Health NHC (HMO D-SNP)	01	01		1			H2224	003	0	2023	Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor		2		2			1	3		1					1	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(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	6	1	2	1	2		0	07/15/2022	2023.01	07/15/2022 02:51:50 PM Eastern Daylight Time	08/05/2022 11:07:07 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time			08/05/2022 06:37:15 PM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance  Massachusetts	www.commonwealthcarealliance.org/become-a-member	CCA Senior Care Options (HMO D-SNP)	01	01		1			H2225	001	0	2023	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	2	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 04:34:05 PM Central Daylight Time	08/03/2022 11:34:09 AM Central Daylight Time	07/31/2022 01:06:45 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Senior Care Options (HMO D-SNP)	01	01		1			H2226	001	0	2023	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	2	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 04:35:37 PM Central Daylight Time	08/03/2022 11:34:49 AM Central Daylight Time	07/31/2022 01:07:09 AM Central Daylight Time			08/04/2022 02:21:09 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	2023	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	4	1		1	2		0	08/15/2022	2023.01	08/15/2022 11:07:06 AM Central Daylight Time	08/03/2022 10:40:01 AM Central Daylight Time	07/31/2022 01:07:34 AM Central Daylight Time			08/15/2022 03:33:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2228	002	0	2023	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	08/15/2022	2023.01	08/15/2022 11:07:14 AM Central Daylight Time	08/03/2022 10:40:40 AM Central Daylight Time	07/31/2022 01:07:58 AM Central Daylight Time			08/15/2022 03:33:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2228	010	0	2023	Select Counties in DE and MD		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	08/15/2022	2023.01	08/15/2022 11:07:23 AM Central Daylight Time	08/03/2022 10:41:17 AM Central Daylight Time	07/31/2022 01:08:22 AM Central Daylight Time			08/15/2022 03:33:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H2228	011	0	2023	Montgomery and Prince George's 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			
H2228	013	0	1	04	01	H2228_013_0	3	1		1	2		0	08/15/2022	2023.01	08/15/2022 11:07:31 AM Central Daylight Time	08/03/2022 10:41:54 AM Central Daylight Time	07/31/2022 01:08:46 AM Central Daylight Time			08/15/2022 03:33:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2228	013	0	2023	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	5	1		1	2		0	08/15/2022	2023.01	08/15/2022 11:07:41 AM Central Daylight Time	08/03/2022 10:42:31 AM Central Daylight Time	07/31/2022 01:09:11 AM Central Daylight Time			08/15/2022 03:33:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2228	016	0	2023	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	08/15/2022	2023.01	08/15/2022 11:07:51 AM Central Daylight Time	08/03/2022 10:43:08 AM Central Daylight Time	07/31/2022 01:09:35 AM Central Daylight Time			08/15/2022 03:33:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 1 (PPO I-SNP)	01	04		1			H2228	017	0	2023	Select Counties in Oregon		2		2			1	1	2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	018	0	1	04	01	H2228_018_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 09:50:03 AM Central Daylight Time	08/03/2022 10:43:45 AM Central Daylight Time	07/31/2022 01:09:59 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Flex Plan 1 (PPO)	01	04		1			H2228	018	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:37:17 AM Central Daylight Time	08/03/2022 10:44:22 AM Central Daylight Time	07/31/2022 01:10:24 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	019	0	2023	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	08/03/2022	2023.01	08/03/2022 10:42:30 AM Central Daylight Time	08/03/2022 10:44:59 AM Central Daylight Time	07/31/2022 01:10:48 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (PPO)	01	04		1			H2228	020	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:43:56 AM Central Daylight Time	08/03/2022 10:45:37 AM Central Daylight Time	07/31/2022 01:11:12 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	021	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:46:01 AM Central Daylight Time	08/03/2022 10:46:15 AM Central Daylight Time	07/31/2022 01:11:37 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	022	0	2023	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	08/03/2022	2023.01	08/03/2022 05:38:36 PM Central Daylight Time	08/03/2022 10:46:51 AM Central Daylight Time	07/31/2022 01:12:01 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	023	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:39:34 PM Central Daylight Time	08/03/2022 10:47:28 AM Central Daylight Time	07/31/2022 01:12:25 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	024	0	2023	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	1	1			2	0	0	06/02/2022	2023.01	06/02/2022 09:06:40 AM Central Daylight Time	06/01/2022 10:49:14 AM Central Daylight Time				06/03/2022 10:34:06 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	025	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:47:27 AM Central Daylight Time	08/03/2022 10:48:05 AM Central Daylight Time	07/31/2022 01:12:49 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	029	0	2023	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			
H2228	030	0	1	04	01	H2228_030_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 04:01:14 PM Central Daylight Time	08/03/2022 10:48:41 AM Central Daylight Time	07/31/2022 01:13:13 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	030	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 03:55:11 PM Central Daylight Time	08/03/2022 10:49:19 AM Central Daylight Time	07/31/2022 01:13:37 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	031	0	2023	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	2	1			2		1	06/01/2022	2023.01	06/01/2022 01:41:22 PM Central Daylight Time	08/03/2022 10:49:56 AM Central Daylight Time	07/31/2022 01:14:01 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	032	0	2023	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	2	1			2		1	08/04/2022	2023.01	08/04/2022 12:53:28 PM Central Daylight Time	08/03/2022 10:50:33 AM Central Daylight Time	07/31/2022 01:14:25 AM Central Daylight Time			08/04/2022 04:32:59 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	035	0	2023	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	06/01/2022	2023.01	06/01/2022 02:50:02 PM Central Daylight Time	08/03/2022 10:51:09 AM Central Daylight Time	07/31/2022 01:14:49 AM Central Daylight Time			08/04/2022 04:32:59 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	036	0	2023	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	2	1			2		1	06/01/2022	2023.01	06/01/2022 10:18:28 AM Central Daylight Time	08/03/2022 10:51:45 AM Central Daylight Time	07/31/2022 01:15:13 AM Central Daylight Time			08/04/2022 04:32:59 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	037	0	2023	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	08/15/2022	2023.01	08/15/2022 11:08:00 AM Central Daylight Time	08/03/2022 10:52:22 AM Central Daylight Time	07/31/2022 01:15:37 AM Central Daylight Time			08/15/2022 03:33:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 1 (PPO I-SNP)	01	04		1			H2228	039	0	2023	Providence and Washington 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			
H2228	041	0	1	04	01	H2228_041_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:38:48 PM Central Daylight Time	08/03/2022 10:53:00 AM Central Daylight Time	07/31/2022 01:16:02 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice Premier (PPO D-SNP)	01	04		1			H2228	041	0	2023	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	08/04/2022	2023.01	08/04/2022 01:30:29 PM Central Daylight Time	08/03/2022 10:53:37 AM Central Daylight Time	07/31/2022 01:16:26 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H2228	043	0	2023	State of Hawaii		2		2			1	3		1					1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	044	0	1	04	01	H2228_044_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 03:19:53 PM Central Daylight Time	08/03/2022 10:54:15 AM Central Daylight Time	07/31/2022 01:16:51 AM Central Daylight Time			08/04/2022 04:39:45 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H2228	044	0	2023	Atlanta and Macon Metro Areas		2		2			1	3		2					2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	045	0	1	04	01	H2228_045_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 10:11:02 AM Central Daylight Time	08/03/2022 10:54:53 AM Central Daylight Time	07/31/2022 01:17:15 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Choice (PPO D-SNP)	01	04		1			H2228	045	0	2023	Washington, DC		2		2			1	3		1					2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)242-7726		(866)242-7726		(888)834-3721		(888)834-3721		(866)242-7726		(866)242-7726		(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	2	1			2		1	08/03/2022	2023.01	08/03/2022 08:44:50 AM Central Daylight Time	08/03/2022 10:55:31 AM Central Daylight Time	07/31/2022 01:17:40 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	047	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 11:32:17 AM Central Daylight Time	08/03/2022 10:56:13 AM Central Daylight Time	07/31/2022 01:18:04 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	049	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:47:16 AM Central Daylight Time	08/03/2022 10:56:52 AM Central Daylight Time	07/31/2022 01:18:28 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	064	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:48:29 AM Central Daylight Time	08/03/2022 10:57:30 AM Central Daylight Time	07/31/2022 01:18:52 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	065	0	2023	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	067	0	1	04	01	H2228_067_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:42:19 PM Central Daylight Time	08/03/2022 10:58:08 AM Central Daylight Time	07/31/2022 01:19:16 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	067	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:46:04 PM Central Daylight Time	08/03/2022 10:58:49 AM Central Daylight Time	07/31/2022 01:19:40 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	068	0	2023	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	08/03/2022	2023.01	08/03/2022 04:04:48 PM Central Daylight Time	08/03/2022 10:59:29 AM Central Daylight Time	07/31/2022 01:20:04 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	071	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 11:33:56 AM Central Daylight Time	08/03/2022 11:00:10 AM Central Daylight Time	07/31/2022 01:20:28 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (PPO)	01	04		1			H2228	074	0	2023	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			
H2228	075	0	1	04	01	H2228_075_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 11:36:52 AM Central Daylight Time	08/03/2022 11:00:51 AM Central Daylight Time	07/31/2022 01:20:52 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (PPO)	01	04		1			H2228	075	0	2023	Pima county		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			
H2228	076	0	1	04	01	H2228_076_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 11:45:29 AM Central Daylight Time	08/03/2022 11:01:31 AM Central Daylight Time	07/31/2022 01:21:16 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	076	0	2023	Select counties in Arizona		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			
H2228	077	0	1	04	01	H2228_077_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 11:46:34 AM Central Daylight Time	08/03/2022 11:02:12 AM Central Daylight Time	07/31/2022 01:21:40 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (PPO)	01	04		1			H2228	077	0	2023	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			
H2228	079	0	1	04	01	H2228_079_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 09:20:22 AM Central Daylight Time	08/04/2022 11:33:10 AM Central Daylight Time	07/31/2022 01:22:04 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 3 (PPO)	01	04		1			H2228	079	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:49:22 AM Central Daylight Time	08/03/2022 11:03:34 AM Central Daylight Time	07/31/2022 01:22:28 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	080	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:50:25 AM Central Daylight Time	08/03/2022 11:04:15 AM Central Daylight Time	07/31/2022 01:22:52 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	081	0	2023	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	08/03/2022	2023.01	08/03/2022 04:08:29 PM Central Daylight Time	08/03/2022 11:04:55 AM Central Daylight Time	07/31/2022 01:23:16 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	082	0	2023	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	08/03/2022	2023.01	08/03/2022 04:11:20 PM Central Daylight Time	08/03/2022 11:05:36 AM Central Daylight Time	07/31/2022 01:23:40 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2228	083	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:51:24 AM Central Daylight Time	08/03/2022 11:06:16 AM Central Daylight Time	07/31/2022 01:24:05 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2228	084	0	2023	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			
H2228	085	0	1	04	01	H2228_085_0	2	1			2		1	08/04/2022	2023.01	08/04/2022 12:54:19 PM Central Daylight Time	08/03/2022 11:06:57 AM Central Daylight Time	07/31/2022 01:24:28 AM Central Daylight Time			08/04/2022 04:32:59 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	085	0	2023	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	08/04/2022	2023.01	08/04/2022 12:54:35 PM Central Daylight Time	08/03/2022 11:07:37 AM Central Daylight Time	07/31/2022 01:24:53 AM Central Daylight Time			08/04/2022 04:32:59 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 3 (PPO)	01	04		1			H2228	086	0	2023	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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 10:47:34 AM Central Daylight Time	06/01/2022 11:10:37 AM Central Daylight Time				06/03/2022 10:34:06 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	088	0	2023	Select Oregon 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			
H2228	091	0	1	04	01	H2228_091_0	1	1			2	0	0	06/02/2022	2023.01	06/02/2022 01:45:33 PM Central Daylight Time	06/01/2022 11:22:19 AM Central Daylight Time				06/03/2022 10:37:20 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	091	0	2023	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	2	1			2		1	08/04/2022	2023.01	08/04/2022 12:54:47 PM Central Daylight Time	08/03/2022 10:40:06 AM Central Daylight Time	07/31/2022 01:25:16 AM Central Daylight Time			08/04/2022 04:32:59 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	093	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:01:33 PM Central Daylight Time	08/03/2022 10:40:43 AM Central Daylight Time	07/31/2022 01:25:40 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	094	0	2023	Select counties in Arizona		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			
H2228	095	0	1	04	01	H2228_095_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 10:31:58 PM Central Daylight Time	06/01/2022 10:15:01 AM Central Daylight Time				06/02/2022 01:13:21 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	095	0	2023	State of Arizona		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(877)370-2843		(877)370-2843		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	096	0	1	04	01	H2228_096_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:05:13 PM Central Daylight Time	08/03/2022 10:41:19 AM Central Daylight Time	07/31/2022 01:26:05 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (PPO)	01	04		1			H2228	096	0	2023	Pima County		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			
H2228	097	0	1	04	01	H2228_097_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:10:11 PM Central Daylight Time	08/03/2022 10:41:55 AM Central Daylight Time	07/31/2022 01:26:29 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 3 (PPO)	01	04		1			H2228	097	0	2023	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			
H2228	098	0	1	04	01	H2228_098_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 10:37:35 PM Central Daylight Time	06/01/2022 10:16:51 AM Central Daylight Time				06/02/2022 01:13:21 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	098	0	2023	Select Counties Greater NM Area		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(877)370-2843		(877)370-2843		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	099	0	1	04	01	H2228_099_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:12:28 AM Central Daylight Time	08/03/2022 10:42:32 AM Central Daylight Time	07/31/2022 01:26:52 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	099	0	2023	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	08/02/2022	2023.01	08/02/2022 04:14:04 PM Central Daylight Time	08/03/2022 10:43:08 AM Central Daylight Time	07/31/2022 01:27:16 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	100	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 09:58:43 AM Central Daylight Time	08/03/2022 10:43:45 AM Central Daylight Time	07/31/2022 01:27:41 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	101	0	2023	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	2	1			2		1	05/31/2022	2023.01	05/31/2022 02:51:20 PM Central Daylight Time	08/03/2022 10:44:22 AM Central Daylight Time	07/31/2022 01:28:05 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	102	0	2023	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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 10:05:24 AM Central Daylight Time	06/01/2022 10:19:56 AM Central Daylight Time				06/02/2022 01:28:29 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	103	0	2023	State of 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	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:51:16 AM Central Daylight Time	08/03/2022 10:45:00 AM Central Daylight Time	07/31/2022 01:28:29 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	110	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 10:52:31 AM Central Daylight Time	08/03/2022 10:45:37 AM Central Daylight Time	07/31/2022 01:28:53 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	111	0	2023	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	08/02/2022	2023.01	08/02/2022 01:13:53 PM Central Daylight Time	08/03/2022 10:46:14 AM Central Daylight Time	07/31/2022 01:29:17 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	115	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 04:36:28 PM Central Daylight Time	08/03/2022 10:46:50 AM Central Daylight Time	07/31/2022 01:29:41 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	116	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 04:36:47 PM Central Daylight Time	08/03/2022 10:47:27 AM Central Daylight Time	07/31/2022 01:30:05 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	117	0	2023	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	2	1			2		1	08/04/2022	2023.01	08/04/2022 10:07:42 AM Central Daylight Time	08/03/2022 10:48:04 AM Central Daylight Time	07/31/2022 01:30:29 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	118	0	2023	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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 10:44:23 PM Central Daylight Time	06/01/2022 10:24:17 AM Central Daylight Time				06/02/2022 01:13:21 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	119	0	2023	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	120	0	1	04	01	H2228_120_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:47:04 PM Central Daylight Time	08/03/2022 10:48:40 AM Central Daylight Time	07/31/2022 01:30:52 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	120	0	2023	Hawaii 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	121	0	1	04	01	H2228_121_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 10:50:13 AM Central Daylight Time	06/01/2022 10:25:32 AM Central Daylight Time				06/03/2022 10:34:06 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	121	0	2023	Hawaii county		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	124	0	1	04	01	H2228_124_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 04:00:45 PM Central Daylight Time	08/03/2022 10:49:18 AM Central Daylight Time	07/31/2022 01:31:16 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Rebate (PPO)	01	04		1			H2228	124	0	2023	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	125	0	1	04	01	H2228_125_0	2	1			2		1	08/04/2022	2023.01	08/04/2022 10:02:00 AM Central Daylight Time	08/03/2022 10:49:55 AM Central Daylight Time	07/31/2022 01:31:41 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Rebate (PPO)	01	04		1			H2228	125	0	2023	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	126	0	1	04	01	H2228_126_0	2	1			2		1	08/04/2022	2023.01	08/04/2022 10:06:00 AM Central Daylight Time	08/03/2022 10:50:32 AM Central Daylight Time	07/31/2022 01:32:05 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Rebate (PPO)	01	04		1			H2228	126	0	2023	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	127	0	1	04	01	H2228_127_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 10:01:27 AM Central Daylight Time	08/03/2022 10:51:08 AM Central Daylight Time	07/31/2022 01:32:29 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Flex Plan 2 (PPO)	01	04		1			H2228	127	0	2023	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	128	0	1	04	01	H2228_128_0	3	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 08:47:21 AM Central Daylight Time	08/03/2022 10:51:44 AM Central Daylight Time	07/31/2022 01:32:53 AM Central Daylight Time			08/12/2022 10:01:01 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Choice Unity (PPO D-SNP)	01	04		1			H2228	128	0	2023	Washington, DC		2		2			1	3		2					2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)242-7726		(866)242-7726		(888)834-3721		(888)834-3721		(866)242-7726		(866)242-7726		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	129	0	1	04	01	H2228_129_0	2	1			2		1	08/04/2022	2023.01	08/04/2022 12:55:02 PM Central Daylight Time	08/03/2022 10:52:21 AM Central Daylight Time	07/31/2022 01:33:17 AM Central Daylight Time			08/04/2022 04:32:59 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	129	0	2023	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	130	0	1	04	01	H2228_130_0	2	1			2		1	08/04/2022	2023.01	08/04/2022 12:55:18 PM Central Daylight Time	08/03/2022 10:52:58 AM Central Daylight Time	07/31/2022 01:33:42 AM Central Daylight Time			08/04/2022 04:32:59 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Rebate (PPO)	01	04		1			H2228	130	0	2023	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	131	0	1	04	01	H2228_131_0	2	1			2		1	08/04/2022	2023.01	08/04/2022 12:55:32 PM Central Daylight Time	08/03/2022 10:53:35 AM Central Daylight Time	07/31/2022 01:34:06 AM Central Daylight Time			08/04/2022 04:32:59 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 3 (PPO)	01	04		1			H2228	131	0	2023	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	805	0	1	04	01	H2228_805_0	1	1						06/03/2022	2023.01	06/03/2022 10:13:30 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	805	0	2023	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	06/03/2022	2023.01	06/03/2022 10:25:24 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	807	0	2023	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						06/03/2022	2023.01	06/03/2022 10:25:45 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	808	0	2023	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						06/03/2022	2023.01	06/03/2022 10:26:03 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	809	0	2023	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	06/03/2022	2023.01	06/03/2022 10:26:27 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	810	0	2023	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						06/03/2022	2023.01	06/03/2022 10:27:32 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	811	0	2023	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						06/03/2022	2023.01	06/03/2022 10:27:51 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	812	0	2023	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						06/03/2022	2023.01	06/03/2022 10:28:12 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	813	0	2023	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						06/03/2022	2023.01	06/03/2022 10:28:32 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	814	0	2023	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	06/03/2022	2023.01	06/03/2022 10:28:50 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	815	0	2023	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						06/03/2022	2023.01	06/03/2022 10:29:06 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	816	0	2023	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						06/03/2022	2023.01	06/03/2022 10:29:23 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	817	0	2023	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	06/03/2022	2023.01	06/03/2022 10:29:46 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	818	0	2023	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						06/03/2022	2023.01	06/03/2022 10:30:28 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	819	0	2023	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						06/03/2022	2023.01	06/03/2022 10:30:44 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	820	0	2023	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						06/03/2022	2023.01	06/03/2022 10:31:01 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	821	0	2023	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	06/03/2022	2023.01	06/03/2022 10:31:20 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	822	0	2023	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						06/03/2022	2023.01	06/03/2022 10:31:40 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	823	0	2023	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						06/03/2022	2023.01	06/03/2022 10:32:26 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	824	0	2023	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						06/03/2022	2023.01	06/03/2022 10:32:44 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	825	0	2023	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						06/03/2022	2023.01	06/03/2022 10:33:02 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	826	0	2023	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						06/03/2022	2023.01	06/03/2022 10:33:21 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	827	0	2023	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						06/03/2022	2023.01	06/03/2022 10:33:40 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	828	0	2023	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						06/03/2022	2023.01	06/03/2022 10:33:57 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	829	0	2023	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	06/03/2022	2023.01	06/03/2022 10:34:12 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	830	0	2023	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						06/03/2022	2023.01	06/03/2022 10:34:28 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	831	0	2023	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						06/03/2022	2023.01	06/03/2022 10:34:44 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	832	0	2023	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						06/03/2022	2023.01	06/03/2022 10:35:00 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	833	0	2023	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						06/03/2022	2023.01	06/03/2022 10:35:16 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	834	0	2023	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						06/03/2022	2023.01	06/03/2022 10:35:34 AM Eastern Daylight Time					06/03/2022 03:39:34 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	835	0	2023	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						06/03/2022	2023.01	06/03/2022 10:16:01 AM Eastern Daylight Time					06/03/2022 03:41:11 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	836	0	2023	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						06/03/2022	2023.01	06/03/2022 10:23:20 AM Eastern Daylight Time					06/03/2022 03:41:11 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	837	0	2023	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	838	0	1	04	01	H2228_838_0	1	1						06/03/2022	2023.01	06/03/2022 10:24:01 AM Eastern Daylight Time					06/03/2022 03:41:11 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	838	0	2023	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	8	1					1	07/11/2022	2023.01	07/11/2022 11:59:06 AM Eastern Daylight Time	08/03/2022 03:39:20 PM Eastern Daylight Time	08/03/2022 03:35:48 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire Dukes and Nantucket		2		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	8	1					1	08/03/2022	2023.01	08/03/2022 03:27:39 PM Eastern Daylight Time	08/03/2022 03:41:15 PM Eastern Daylight Time	08/03/2022 03:36:15 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire Dukes and Nantucket		2		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	8	1					1	07/11/2022	2023.01	07/11/2022 12:00:50 PM Eastern Daylight Time	08/03/2022 03:43:13 PM Eastern Daylight Time	08/03/2022 03:36:42 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire Dukes and Nantucket	Massachusetts except BER, DUK, NAN, WOR	2		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	8	1					1	07/11/2022	2023.01	07/11/2022 12:00:59 PM Eastern Daylight Time	08/03/2022 03:45:00 PM Eastern Daylight Time	08/03/2022 03:37:09 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire Dukes and Nantucket	Worcester, MA	2		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	5	1						06/03/2022	2023.01	06/03/2022 04:02:13 PM Eastern Daylight Time					06/05/2022 10:10:09 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	2023	National Network		1	1666	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;14a;15;	2		1									
H2230	809	0	1	04	01	H2230_809_0	5	1				0	0	06/03/2022	2023.01	06/03/2022 04:02:17 PM Eastern Daylight Time					06/05/2022 10:10:09 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	2023	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;14a;15;	2		1									
H2235	001	0	1	01	01	H2235_001_0	4	1					1	08/04/2022	2023.01	08/04/2022 05:52:05 PM Eastern Daylight Time	08/04/2022 12:31:39 PM Eastern Daylight Time	08/02/2022 09:51:03 AM Eastern Daylight Time			08/04/2022 06:00:36 PM Eastern Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus Complete (HMO)	01	01		1			H2235	001	0	2023	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	4	1					0	07/18/2022	2023.01	07/18/2022 09:44:59 AM Eastern Daylight Time	08/04/2022 12:30:50 PM Eastern Daylight Time	08/02/2022 09:54:07 AM Eastern Daylight Time			08/04/2022 06:00:36 PM Eastern Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus Rewards (HMO)	01	01		1			H2235	002	0	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 05:52:34 PM Eastern Daylight Time	08/04/2022 12:30:13 PM Eastern Daylight Time	08/02/2022 09:56:35 AM Eastern Daylight Time			08/04/2022 06:00:36 PM Eastern Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus Premier (HMO)	01	01		1			H2235	003	0	2023	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						06/05/2022	2023.01	06/05/2022 08:31:01 PM Eastern Daylight Time					06/06/2022 04:52:10 PM Eastern Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus EGWP MAPD calendar (HMO)	01	01		1			H2235	801	0	2023	Hillsborough, Pasco, Pinellas and Polk counties		1	0	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						06/05/2022	2023.01	06/05/2022 08:38:04 PM Eastern Daylight Time					06/06/2022 04:52:10 PM Eastern Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus EGWP MAPD non calendar (HMO)	01	01		1			H2235	802	0	2023	Hillsborough, Pasco, Pinellas and Polk counties		1	0	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	06/05/2022	2023.01	06/05/2022 08:41:27 PM Eastern Daylight Time					06/06/2022 04:52:10 PM Eastern 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	2023	Hillsborough, Pasco, Pinellas and Polk counties		1	0	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	2	1				0	0	06/05/2022	2023.01	06/05/2022 08:51:12 PM Eastern Daylight Time					06/06/2022 04:52:10 PM Eastern 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	2023	Hillsborough, Pasco, Pinellas and Polk counties		1	0	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	6	1	2	1	1		0	06/06/2022	2023.01	06/06/2022 03:54:52 PM Eastern Daylight Time	08/04/2022 01:14:36 PM Eastern Daylight Time	07/30/2022 06:26:36 AM Eastern Daylight Time			08/04/2022 06:49:07 PM Eastern Daylight Time	INDEPENDENT CARE HEALTH PLAN	iCare	www.icarehealthplan.org	iCare Medicare Plan (HMO D-SNP)	01	01		1			H2237	001	0	2023	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	5	1	2	1	1		0	06/06/2022	2023.01	06/06/2022 10:23:31 AM Eastern Daylight Time	08/04/2022 01:19:16 PM Eastern Daylight Time	07/30/2022 06:27:00 AM Eastern Daylight Time			08/04/2022 06:45:17 PM Eastern Daylight Time	INDEPENDENT CARE HEALTH PLAN	iCare	www.icarehealthplan.org	iCare Family Care Partnership (HMO D-SNP)	01	01		1			H2237	007	0	2023	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			
H2246	018	0	1	04	01	H2246_018_0	12	1					1	08/04/2022	2023.01	08/04/2022 10:10:24 PM Mountain Daylight Time	08/05/2022 10:55:53 AM Mountain Daylight Time	08/05/2022 10:55:53 AM Mountain Daylight Time			08/05/2022 11:31:07 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	https://selecthealth.org/medicare	SelectHealth Medicare Choice (PPO)	01	04		1			H2246	018	0	2023	Northern and Southwest Utah		2		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		(855)442-9900		(801)442-9900		(855)442-9940		(801)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2						2			
H2246	019	0	1	04	01	H2246_019_0	12	1					1	08/04/2022	2023.01	08/04/2022 01:46:20 PM Mountain Daylight Time	08/05/2022 10:55:53 AM Mountain Daylight Time	08/05/2022 10:55:53 AM Mountain Daylight Time			08/05/2022 11:31:07 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	https://selecthealth.org/medicare	SelectHealth Medicare Choice (PPO)	01	04		1			H2246	019	0	2023	Clark and Nye Counties		2		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			
H2246	020	0	1	04	01	H2246_020_0	9	1				0	0	07/12/2022	2023.01	07/12/2022 01:45:48 PM Mountain Daylight Time	06/06/2022 11:38:45 PM Mountain Daylight Time				06/06/2022 11:41:20 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	https://selecthealth.org/medicare	SelectHealth Medicare NoRx (PPO)	01	04		1			H2246	020	0	2023	Clark and Nye Counties		2		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										(800)346-4128		(711)-		(800)346-4128		(711)-										2					2						2			
H2247	001	0	1	02	01	H2247_001_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 01:28:46 PM Central Daylight Time	08/03/2022 11:33:10 AM Central Daylight Time	07/31/2022 01:34:30 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H2247	001	0	2023	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			
H2247	003	0	1	02	01	H2247_003_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 03:57:52 PM Central Daylight Time	08/03/2022 11:33:47 AM Central Daylight Time	07/31/2022 01:34:54 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H2247	003	0	2023	Select Counties in Michigan		2		2			1	3		2					2	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	8	1						07/19/2022	2023.01	07/19/2022 03:15:36 PM Eastern Daylight Time	08/04/2022 05:34:43 PM Eastern Daylight Time	08/02/2022 02:14:56 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	1	2023	Most of Massachusetts	Essex and Suffolk Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 03:19:35 PM Eastern Daylight Time	08/04/2022 05:36:04 PM Eastern Daylight Time	08/02/2022 02:15:16 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	2	2023	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 05:00:38 PM Eastern Daylight Time	08/04/2022 05:37:12 PM Eastern Daylight Time	08/02/2022 02:15:36 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	6	2023	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 03:26:25 PM Eastern Daylight Time	08/04/2022 05:38:26 PM Eastern Daylight Time	08/02/2022 02:15:54 PM Eastern Daylight Time			08/05/2022 02:26:32 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	2023	Most of Massachusetts	Essex and Suffolk Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 03:43:40 PM Eastern Daylight Time	08/04/2022 05:39:41 PM Eastern Daylight Time	08/02/2022 02:16:14 PM Eastern Daylight Time			08/05/2022 02:26:32 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	2023	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 03:48:57 PM Eastern Daylight Time	08/04/2022 05:40:50 PM Eastern Daylight Time	08/02/2022 02:16:34 PM Eastern Daylight Time			08/05/2022 02:26:32 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	2023	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	6	1				0	0	07/19/2022	2023.01	07/19/2022 03:51:40 PM Eastern Daylight Time	06/03/2022 09:51:36 PM Eastern Daylight Time				07/19/2022 06:30:50 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	2023	Most of Massachusetts	Essex and Suffolk Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	07/19/2022	2023.01	07/19/2022 03:54:25 PM Eastern Daylight Time	06/03/2022 09:50:35 PM Eastern Daylight Time				07/19/2022 06:30:50 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	2023	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 03:57:34 PM Eastern Daylight Time	08/04/2022 05:42:07 PM Eastern Daylight Time	08/02/2022 02:16:54 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	1	2023	Most of Massachusetts	Essex and Suffolk Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 04:01:10 PM Eastern Daylight Time	08/04/2022 05:43:35 PM Eastern Daylight Time	08/02/2022 02:17:14 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	7	2023	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 04:04:59 PM Eastern Daylight Time	08/04/2022 05:44:49 PM Eastern Daylight Time	08/02/2022 02:17:34 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	8	2023	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	6	1				0	0	07/19/2022	2023.01	07/19/2022 04:09:14 PM Eastern Daylight Time	06/03/2022 09:46:29 PM Eastern Daylight Time				07/19/2022 06:30:50 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	2023	Most of Massachusetts	Essex and Suffolk Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	6	1				0	0	07/19/2022	2023.01	07/19/2022 04:15:15 PM Eastern Daylight Time	06/03/2022 09:45:23 PM Eastern Daylight Time				07/19/2022 06:30:50 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	2023	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 04:24:29 PM Eastern Daylight Time	08/04/2022 05:46:03 PM Eastern Daylight Time	08/02/2022 02:17:54 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	1	2023	Most of Massachusetts	Essex and Suffolk Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 04:25:29 PM Eastern Daylight Time	08/04/2022 05:47:11 PM Eastern Daylight Time	08/02/2022 02:18:14 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	2	2023	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 04:30:27 PM Eastern Daylight Time	08/04/2022 05:48:25 PM Eastern Daylight Time	08/02/2022 02:18:36 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	3	2023	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						08/02/2022	2023.01	08/02/2022 04:10:24 PM Eastern Daylight Time	08/04/2022 05:49:33 PM Eastern Daylight Time	08/02/2022 02:18:56 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Saver Rx (HMO)	01	01		1			H2256	028	0	2023	Most of Massachusetts		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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						06/01/2022	2023.01	06/01/2022 05:22:49 PM Eastern Daylight Time	08/04/2022 05:50:56 PM Eastern Daylight Time	08/02/2022 02:19:16 PM Eastern Daylight Time			08/05/2022 02:26:32 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	2023	Worcester County		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 03:45:34 PM Eastern Daylight Time	08/04/2022 05:52:00 PM Eastern Daylight Time	08/02/2022 02:19:36 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	034	0	2023	Worcester County		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						07/19/2022	2023.01	07/19/2022 02:55:56 PM Eastern Daylight Time	08/04/2022 05:53:08 PM Eastern Daylight Time	08/02/2022 02:19:56 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	036	0	2023	Worcester County		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	06/01/2022	2023.01	06/01/2022 05:25:15 PM Eastern Daylight Time	06/03/2022 09:36:54 PM Eastern Daylight Time				07/19/2022 06:30:50 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	2023	Worcester County		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	6	1				0	0	07/19/2022	2023.01	07/19/2022 02:57:26 PM Eastern Daylight Time	06/03/2022 09:35:23 PM Eastern Daylight Time				07/19/2022 06:30:50 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	2023	Worcester County		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	6	1				0	0	07/19/2022	2023.01	07/19/2022 02:59:12 PM Eastern Daylight Time	06/03/2022 09:33:58 PM Eastern Daylight Time				07/19/2022 06:30:50 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	2023	Worcester County		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	6	1				0	0	07/19/2022	2023.01	07/19/2022 03:00:57 PM Eastern Daylight Time	06/03/2022 09:32:48 PM Eastern Daylight Time				07/19/2022 06:30:50 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	2023	Essex and Suffolk Counties		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	8	1						08/02/2022	2023.01	08/02/2022 04:12:25 PM Eastern Daylight Time	08/04/2022 05:54:51 PM Eastern Daylight Time	08/02/2022 02:20:16 PM Eastern Daylight Time			08/05/2022 02:26:32 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	2023	Most of Massachusetts		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	2	1						06/06/2022	2023.01	06/06/2022 08:08:28 PM Eastern Daylight Time					07/19/2022 06:30:50 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	2023	Most of Massachusetts		1	79134	2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	2	1				0	0	06/06/2022	2023.01	06/06/2022 08:18:20 PM Eastern Daylight Time					07/19/2022 06:30:50 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	2023	Most of Massachusetts		1	5936	2			2									https://www.tuftsmedicarepreferred.org/drug-coverage	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	2	1						06/06/2022	2023.01	06/06/2022 08:19:43 PM Eastern Daylight Time					07/19/2022 06:30:50 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	2023	Most of Massachusetts		1	0	2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-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	2	1				0	0	06/06/2022	2023.01	06/06/2022 08:21:09 PM Eastern Daylight Time					07/19/2022 06:30:50 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	2023	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	8	1					1	07/11/2022	2023.01	07/11/2022 12:02:05 PM Eastern Daylight Time	08/03/2022 03:46:58 PM Eastern Daylight Time	08/03/2022 03:37:36 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire Dukes and Nantucket		2		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	8	1					1	07/11/2022	2023.01	07/11/2022 12:02:18 PM Eastern Daylight Time	08/03/2022 03:48:55 PM Eastern Daylight Time	08/03/2022 03:38:03 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire, Dukes, Nantucket	Massachusetts except BER, DUK, NAN, WOR	2		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	8	1					1	07/11/2022	2023.01	07/11/2022 12:02:30 PM Eastern Daylight Time	08/03/2022 03:50:40 PM Eastern Daylight Time	08/03/2022 03:38:31 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire, Dukes, Nantucket	Worcester county	2		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	8	1					1	07/11/2022	2023.01	07/11/2022 12:02:56 PM Eastern Daylight Time	08/03/2022 03:52:35 PM Eastern Daylight Time	08/03/2022 03:38:59 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire Dukes and Nantucket	Massachusetts except BER, DUK, NAN, WOR	2		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	8	1					1	07/11/2022	2023.01	07/11/2022 12:03:19 PM Eastern Daylight Time	08/03/2022 03:54:26 PM Eastern Daylight Time	08/03/2022 03:39:26 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire Dukes and Nantucket	Worcester, MA	2		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	8	1					1	08/03/2022	2023.01	08/03/2022 03:17:54 PM Eastern Daylight Time	08/03/2022 03:56:23 PM Eastern Daylight Time	08/03/2022 03:39:54 PM Eastern Daylight Time			08/04/2022 01:08:39 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	2023	Massachusetts except Berkshire Dukes and Nantucket		2		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	5	1						06/03/2022	2023.01	06/03/2022 04:02:47 PM Eastern Daylight Time					06/05/2022 10:10:09 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	2023	Massachusetts except Berkshire Dukes and Nantucket		1	14086	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;9b;9c;10a;11a;11c;12;14a;15;	1	7d;7f;7i;14e1;14e2;14e3;14e4;14e5;	1					2				
H2261	809	0	1	01	01	H2261_809_0	5	1				0	0	06/03/2022	2023.01	06/03/2022 04:02:52 PM Eastern Daylight Time					06/05/2022 10:10:09 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	2023	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;14a;15;	1	7d;7f;7i;14e1;14e2;14e3;14e4;14e5;	1					2				
H2272	001	0	1	02	01	H2272_001_0	2	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 04:38:09 PM Central Daylight Time	08/03/2022 11:30:38 AM Central Daylight Time	07/31/2022 01:35:19 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H2272	001	0	2023	State of Rhode Island		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			
H2292	001	0	1	04	01	H2292_001_0	3	1		1			0	08/15/2022	2023.01	08/15/2022 11:08:14 AM Central Daylight Time	08/03/2022 11:34:31 AM Central Daylight Time	07/31/2022 01:35:44 AM Central Daylight Time			08/15/2022 03:55:51 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2292	001	0	2023	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	08/15/2022	2023.01	08/15/2022 11:08:23 AM Central Daylight Time	08/03/2022 11:35:09 AM Central Daylight Time	07/31/2022 01:36:08 AM Central Daylight Time			08/15/2022 03:55:51 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2292	002	0	2023	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	08/15/2022	2023.01	08/15/2022 11:08:32 AM Central Daylight Time	08/03/2022 11:35:48 AM Central Daylight Time	07/31/2022 01:36:33 AM Central Daylight Time			08/15/2022 03:55:51 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H2292	003	0	2023	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			
H2292	004	0	1	04	01	H2292_004_0	3	1		1			1	08/15/2022	2023.01	08/15/2022 11:08:40 AM Central Daylight Time	08/03/2022 11:36:30 AM Central Daylight Time	07/31/2022 01:36:57 AM Central Daylight Time			08/15/2022 03:55:51 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H2292	004	0	2023	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			
H2293	001	0	1	04	01	H2293_001_0	2	1			1		0	08/03/2022	2023.01	08/03/2022 02:18:02 PM Eastern Daylight Time	08/03/2022 02:34:54 PM Eastern Daylight Time	07/31/2022 09:30:20 PM Eastern Daylight Time			08/04/2022 04:36:59 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (PPO)	01	04		1			H2293	001	0	2023	Select Counties in 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			
H2293	002	0	1	04	01	H2293_002_0	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 08:14:22 PM Eastern Daylight Time	08/03/2022 11:57:08 AM Eastern Daylight Time	07/31/2022 09:30:46 PM Eastern Daylight Time			08/04/2022 05:04:37 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Choice Plus Plan (PPO D-SNP)	01	04		1			H2293	002	0	2023	Select Counties in Georgia		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			
H2293	003	0	1	04	01	H2293_003_0	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:21:15 PM Eastern Daylight Time	08/03/2022 12:22:12 PM Eastern Daylight Time	07/31/2022 09:31:12 PM Eastern Daylight Time			08/04/2022 05:04:37 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Choice Plan (PPO D-SNP)	01	04		1			H2293	003	0	2023	Select Counties in Georgia		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			
H2293	004	0	1	04	01	H2293_004_0	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:22:11 PM Eastern Daylight Time	08/03/2022 12:23:10 PM Eastern Daylight Time	07/31/2022 09:31:38 PM Eastern Daylight Time			08/04/2022 05:04:37 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Choice Plan (PPO D-SNP)	01	04		1			H2293	004	0	2023	Select Counties in Georgia		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			
H2293	005	0	1	04	01	H2293_005_0	4	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:25:46 PM Eastern Daylight Time	08/03/2022 12:24:12 PM Eastern Daylight Time	07/31/2022 09:32:02 PM Eastern Daylight Time			08/04/2022 05:04:37 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Choice Plus Plan (PPO D-SNP)	01	04		1			H2293	005	0	2023	Select Counties in Georgia		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			
H2293	006	0	1	04	01	H2293_006_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 05:24:47 PM Eastern Daylight Time	08/03/2022 12:25:12 PM Eastern Daylight Time	07/31/2022 09:32:28 PM Eastern Daylight Time			08/04/2022 04:36:59 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Signature Plan (PPO)	01	04		1			H2293	006	0	2023	Select Counties in 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			
H2293	007	0	1	04	01	H2293_007_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 05:54:39 PM Eastern Daylight Time	08/03/2022 12:26:15 PM Eastern Daylight Time	07/31/2022 09:32:52 PM Eastern Daylight Time			08/04/2022 04:36:59 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plus Plan (PPO)	01	04		1			H2293	007	0	2023	Select Counties in 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			
H2293	008	0	1	04	01	H2293_008_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:00:57 PM Eastern Daylight Time	08/03/2022 12:27:18 PM Eastern Daylight Time	07/31/2022 09:33:18 PM Eastern Daylight Time			08/04/2022 04:36:59 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plus Plan (PPO)	01	04		1			H2293	008	0	2023	Select Counties in 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			
H2293	009	0	1	04	01	H2293_009_0	3	1			2	0	0	06/06/2022	2023.01	06/06/2022 12:11:53 PM Eastern Daylight Time	06/29/2022 01:44:18 PM Eastern Daylight Time				06/30/2022 12:08:22 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plus Plan (PPO)	01	04		1			H2293	009	0	2023	Select Counties in 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2293	010	0	1	04	01	H2293_010_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 03:11:32 PM Eastern Daylight Time	08/03/2022 12:29:26 PM Eastern Daylight Time	07/31/2022 09:33:44 PM Eastern Daylight Time			08/10/2022 03:26:45 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantage Plus Plan (PPO)	01	04		1			H2293	010	0	2023	Select Counties in 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			
H2293	011	0	1	04	01	H2293_011_0	3	1			1		0	08/03/2022	2023.01	08/03/2022 01:33:05 PM Eastern Daylight Time	08/03/2022 02:35:50 PM Eastern Daylight Time	07/31/2022 09:34:08 PM Eastern Daylight Time			08/04/2022 04:36:59 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (PPO)	01	04		1			H2293	011	0	2023	Select Counties in 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			
H2293	012	0	1	04	01	H2293_012_0	2	1			2	0	0	05/31/2022	2023.01	05/31/2022 09:39:47 AM Central Daylight Time	08/02/2022 01:11:28 PM Central Daylight Time				08/05/2022 09:49:14 AM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle II (PPO)	01	04		1			H2293	012	0	2023	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2293	013	0	1	04	01	H2293_013_0	3	1			2		0	08/01/2022	2023.01	08/01/2022 05:50:29 PM Central Daylight Time	08/02/2022 01:12:32 PM Central Daylight Time	07/31/2022 08:34:34 PM Central Daylight Time			08/04/2022 04:04:13 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H2293	013	0	2023	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)570-6670		(833)570-6670		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2293	014	0	1	04	01	H2293_014_0	3	1			2		0	08/01/2022	2023.01	08/01/2022 05:51:39 PM Central Daylight Time	08/02/2022 01:13:35 PM Central Daylight Time	07/31/2022 08:35:00 PM Central Daylight Time			08/04/2022 04:04:13 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Preferred Plan (PPO)	01	04		1			H2293	014	0	2023	North 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			
H2293	015	0	1	04	01	H2293_015_0	2	1			2	0	0	05/31/2022	2023.01	05/31/2022 09:46:14 AM Central Daylight Time	08/02/2022 01:14:38 PM Central Daylight Time				08/05/2022 09:49:14 AM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle II (PPO)	01	04		1			H2293	015	0	2023	Harris, Fort Bend, Montgomery		2		2			2									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			
H2293	016	0	1	04	01	H2293_016_0	3	1			2		0	08/01/2022	2023.01	08/01/2022 05:52:52 PM Central Daylight Time	08/02/2022 01:15:47 PM Central Daylight Time	07/31/2022 08:35:24 PM Central Daylight Time			08/04/2022 04:04:13 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H2293	016	0	2023	Houston 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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2293	017	0	1	04	01	H2293_017_0	3	1			2		0	08/01/2022	2023.01	08/01/2022 05:53:57 PM Central Daylight Time	08/02/2022 01:16:54 PM Central Daylight Time	07/31/2022 08:35:50 PM Central Daylight Time			08/04/2022 04:04:13 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H2293	017	0	2023	RGV 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			
H2293	018	0	1	04	01	H2293_018_0	3	1			2		0	08/01/2022	2023.01	08/01/2022 05:55:09 PM Central Daylight Time	08/02/2022 01:18:05 PM Central Daylight Time	07/31/2022 08:36:16 PM Central Daylight Time			08/04/2022 04:04:13 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H2293	018	0	2023	Austin		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2293	019	0	1	04	01	H2293_019_0	3	1			2		0	08/01/2022	2023.01	08/01/2022 05:56:06 PM Central Daylight Time	08/02/2022 01:19:36 PM Central Daylight Time	07/31/2022 08:36:40 PM Central Daylight Time			08/04/2022 04:04:13 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H2293	019	0	2023	San Antonio 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			
H2293	020	0	1	04	01	H2293_020_0	2	1			2	0	0	05/31/2022	2023.01	05/31/2022 10:14:24 AM Central Daylight Time	08/02/2022 01:20:46 PM Central Daylight Time				08/05/2022 09:49:14 AM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle II Plan (PPO)	01	04		1			H2293	020	0	2023	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2318	001	0	1	20	08	H2318_001_0	1	1						06/02/2022	2023.01	06/02/2022 09:22:51 AM Eastern Daylight Time		05/31/2022 02:35:30 PM Eastern Daylight Time			06/02/2022 09:25:24 AM Eastern Daylight Time	PACE SOUTHEAST MICHIGAN	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	08	20		1			H2318	001	0	2023	Michigan: Macomb, Oakland, Wayne Counties		2		2			2									www.henryford.com	Milwaukee.PACE@milliman.com										(855)445-4554		(855)445-4554		(855)445-4554		(855)445-4554										(711)-		(711)-		(711)-		(711)-																
H2318	002	0	1	20	08	H2318_002_0	1	1						06/02/2022	2023.01	06/02/2022 09:23:32 AM Eastern Daylight Time		05/31/2022 02:35:30 PM Eastern Daylight Time			06/02/2022 09:25:24 AM Eastern Daylight Time	PACE SOUTHEAST MICHIGAN	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	08	20		1			H2318	002	0	2023	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	16	1					1	08/03/2022	2023.01	08/03/2022 07:23:45 PM Eastern Daylight Time	08/04/2022 12:34:26 PM Eastern Daylight Time	07/31/2022 07:21:40 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	1	2023	68 lower peninsula Michigan counties	Region 1	2		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	14	1					1	08/03/2022	2023.01	08/03/2022 07:25:19 PM Eastern Daylight Time	08/04/2022 12:34:52 PM Eastern Daylight Time	07/31/2022 07:22:02 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	2	2023	68 lower peninsula Michigan counties	Region 2	2		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	14	1					1	08/03/2022	2023.01	08/03/2022 07:27:42 PM Eastern Daylight Time	08/04/2022 12:35:18 PM Eastern Daylight Time	07/31/2022 07:22:24 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	3	2023	68 lower peninsula Michigan counties	Region 3	2		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	14	1					1	08/03/2022	2023.01	08/03/2022 07:29:38 PM Eastern Daylight Time	08/04/2022 12:35:42 PM Eastern Daylight Time	07/31/2022 07:22:44 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	4	2023	68 lower peninsula Michigan counties	Region 4	2		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	14	1					1	08/03/2022	2023.01	08/03/2022 07:33:47 PM Eastern Daylight Time	08/04/2022 12:36:08 PM Eastern Daylight Time	07/31/2022 07:23:06 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	5	2023	68 lower peninsula Michigan counties	Region 5	2		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	11	1						07/18/2022	2023.01	07/18/2022 10:47:49 PM Eastern Daylight Time	08/04/2022 12:36:36 PM Eastern Daylight Time	07/31/2022 07:23:28 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	1	2023	68 lower peninsula Michigan counties	Region 1	2		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	11	1						07/18/2022	2023.01	07/18/2022 10:49:06 PM Eastern Daylight Time	08/04/2022 12:37:02 PM Eastern Daylight Time	07/31/2022 07:23:48 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	2	2023	68 lower peninsula Michigan counties	Region 2	2		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	11	1						07/18/2022	2023.01	07/18/2022 10:49:12 PM Eastern Daylight Time	08/04/2022 12:37:28 PM Eastern Daylight Time	07/31/2022 07:24:10 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	3	2023	68 lower peninsula Michigan counties	Region 3	2		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	11	1						07/18/2022	2023.01	07/18/2022 10:49:18 PM Eastern Daylight Time	08/04/2022 12:37:56 PM Eastern Daylight Time	07/31/2022 07:24:32 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	4	2023	68 lower peninsula Michigan counties	Region 4	2		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	11	1						07/18/2022	2023.01	07/18/2022 10:49:24 PM Eastern Daylight Time	08/04/2022 12:38:20 PM Eastern Daylight Time	07/31/2022 07:24:54 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	5	2023	68 lower peninsula Michigan counties	Region 5	2		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	12	1					1	07/19/2022	2023.01	07/19/2022 12:25:38 PM Eastern Daylight Time	08/04/2022 12:38:46 PM Eastern Daylight Time	07/31/2022 07:25:14 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	1	2023	68 lower peninsula Michigan counties	Region 1	2		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	12	1					1	07/19/2022	2023.01	07/19/2022 12:27:38 PM Eastern Daylight Time	08/04/2022 12:39:12 PM Eastern Daylight Time	07/31/2022 07:25:36 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	2	2023	68 lower peninsula Michigan counties	Region 2	2		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	12	1					1	07/19/2022	2023.01	07/19/2022 12:29:07 PM Eastern Daylight Time	08/04/2022 12:39:36 PM Eastern Daylight Time	07/31/2022 07:25:58 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	3	2023	68 lower peninsula Michigan counties	Region 3	2		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	12	1					1	07/19/2022	2023.01	07/19/2022 12:30:23 PM Eastern Daylight Time	08/04/2022 12:40:02 PM Eastern Daylight Time	07/31/2022 07:26:18 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	4	2023	68 lower peninsula Michigan counties	Region 4	2		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	12	1					1	07/19/2022	2023.01	07/19/2022 12:31:32 PM Eastern Daylight Time	08/04/2022 12:40:28 PM Eastern Daylight Time	07/31/2022 07:26:40 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	5	2023	68 lower peninsula Michigan counties	Region 5	2		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	030	1	1	02	01	H2320_030_1	12	1					1	08/11/2022	2023.01	08/11/2022 12:49:54 PM Eastern Daylight Time	08/04/2022 05:33:56 PM Eastern Daylight Time	07/31/2022 07:27:02 AM Eastern Daylight Time			08/11/2022 02:53:08 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare ONE (HMO-POS)	01	02		1			H2320	030	1	2023	Kent, Macomb, Oakland, Ottawa, & Wayne counties	Kent & Ottawa counties	2		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	030	2	1	02	01	H2320_030_2	12	1					1	08/11/2022	2023.01	08/11/2022 12:49:18 PM Eastern Daylight Time	08/04/2022 05:34:22 PM Eastern Daylight Time	07/31/2022 07:27:22 AM Eastern Daylight Time			08/11/2022 02:53:08 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare ONE (HMO-POS)	01	02		1			H2320	030	2	2023	Kent, Macomb, Oakland, Ottawa, & Wayne counties	Macomb, Oakland, & Wayne counties	2		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	6	1						07/19/2022	2023.01	07/19/2022 03:33:28 PM Eastern Daylight Time					07/19/2022 04:27:01 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	2023	National		1	3132	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	6	1						07/19/2022	2023.01	07/19/2022 03:34:40 PM Eastern Daylight Time					07/19/2022 04:27:01 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG Calendar Year (HMO-POS)	01	02		1			H2320	803	0	2023	National		1	265280	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	6	1						07/19/2022	2023.01	07/19/2022 03:35:34 PM Eastern Daylight Time					07/19/2022 04:27:01 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	2023	State of Michigan		1	0	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	6	1						07/19/2022	2023.01	07/19/2022 03:35:48 PM Eastern Daylight Time					07/19/2022 04:27:01 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	2023	State of Michigan		1	8472	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	6	1				0	0	07/19/2022	2023.01	07/19/2022 03:36:27 PM Eastern Daylight Time					07/19/2022 04:27:01 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO Cal Year (HMO)	01	01		1			H2320	810	0	2023	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	6	1				0	0	07/19/2022	2023.01	07/19/2022 03:36:43 PM Eastern Daylight Time					07/19/2022 04:27:01 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	2023	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	6	1				0	0	07/19/2022	2023.01	07/19/2022 03:37:00 PM Eastern Daylight Time					07/19/2022 04:27:01 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	2023	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	6	1				0	0	07/19/2022	2023.01	07/19/2022 03:37:15 PM Eastern Daylight Time					07/19/2022 04:27:01 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	2023	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	8	1					1	08/04/2022	2023.01	08/04/2022 02:59:56 PM Eastern Daylight Time	08/04/2022 09:40:05 PM Eastern Daylight Time	08/04/2022 09:40:05 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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	8	1					1	08/03/2022	2023.01	08/03/2022 09:05:27 AM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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	8	1					1	08/03/2022	2023.01	08/03/2022 09:07:15 AM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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	9	1					1	08/03/2022	2023.01	08/03/2022 09:07:43 AM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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	014	0	1	04	01	H2322_014_0	10	1						08/03/2022	2023.01	08/03/2022 12:28:22 PM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time			08/04/2022 09:47:58 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Medicare Flex (PPO)	01	04		1			H2322	014	0	2023	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	5	1				0	0	04/13/2022	2023.01	04/13/2022 12:27:57 PM Eastern Daylight Time					06/06/2022 01:25:08 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	2023	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	5	1						04/13/2022	2023.01	04/13/2022 12:30:46 PM Eastern Daylight Time					06/06/2022 01:25:08 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	2023	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	005	0	1	04	01	H2334_005_0	5	1					1	08/03/2022	2023.01	08/03/2022 07:52:26 AM Central Daylight Time	08/04/2022 03:27:16 PM Central Daylight Time	08/04/2022 03:36:22 PM Central Daylight Time			08/04/2022 04:25:51 PM Central Daylight Time	CLEAR SPRING HEALTH (SC), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Gold Plus (PPO)	01	04		1			H2334	005	0	2023	Select South Carolina 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			
H2354	015	0	1	01	01	H2354_015_0	7	1			2		1	08/03/2022	2023.01	08/03/2022 09:12:28 AM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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			2		1	08/03/2022	2023.01	08/03/2022 09:13:33 AM Eastern Daylight Time	08/04/2022 09:40:06 PM Eastern Daylight Time	08/04/2022 09:40:07 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	Wayne, Oakland and Macomb counties		2		2			2									www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(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	4b;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	7	1			2	0	0	07/11/2022	2023.01	07/11/2022 10:04:21 AM Eastern Daylight Time	06/06/2022 09:00:55 AM Eastern Daylight Time				07/11/2022 10:16:15 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	2023	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			2		1	08/03/2022	2023.01	08/03/2022 09:18:14 AM Eastern Daylight Time	08/04/2022 09:40:07 PM Eastern Daylight Time	08/04/2022 09:40:07 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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			2		1	08/03/2022	2023.01	08/03/2022 09:18:50 AM Eastern Daylight Time	08/04/2022 09:40:07 PM Eastern Daylight Time	08/04/2022 09:40:07 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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			2		1	08/03/2022	2023.01	08/03/2022 09:19:45 AM Eastern Daylight Time	08/04/2022 09:40:07 PM Eastern Daylight Time	08/04/2022 09:40:07 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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	7	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:11:58 PM Eastern Daylight Time	08/04/2022 09:40:08 PM Eastern Daylight Time	08/04/2022 09:40:04 PM Eastern Daylight Time			08/04/2022 09:47:58 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Medicare Complete Duals (HMO D-SNP)	01	01		1			H2354	025	0	2023	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			2		1	08/03/2022	2023.01	08/03/2022 09:20:45 AM Eastern Daylight Time	08/04/2022 09:40:04 PM Eastern Daylight Time	08/04/2022 09:40:05 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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			2		1	08/03/2022	2023.01	08/03/2022 09:21:25 AM Eastern Daylight Time	08/04/2022 09:40:05 PM Eastern Daylight Time	08/04/2022 09:40:05 PM Eastern Daylight Time			08/04/2022 09:47:58 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	2023	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	028	0	1	01	01	H2354_028_0	11	1			2		1	08/17/2022	2023.01	08/17/2022 09:34:39 AM Eastern Daylight Time	08/04/2022 09:40:05 PM Eastern Daylight Time	08/04/2022 09:40:05 PM Eastern Daylight Time			08/17/2022 09:40:41 AM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP MSUHC Medicare (HMO)	01	01		1			H2354	028	0	2023	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	801	0	1	01	01	H2354_801_0	5	1				0	0	05/28/2022	2023.01	05/28/2022 11:32:31 PM Eastern Daylight Time					06/06/2022 01:25:08 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	2023	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	5	1						04/18/2022	2023.01	04/18/2022 03:11:15 PM Eastern Daylight Time					06/06/2022 01:25:08 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	2023	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						06/02/2022	2023.01	06/02/2022 09:59:30 AM Mountain Daylight Time		05/27/2022 04:44:18 PM Mountain Daylight Time			06/02/2022 10:00:35 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	2023	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						06/02/2022	2023.01	06/02/2022 09:59:47 AM Mountain Daylight Time		05/27/2022 04:46:08 PM Mountain Daylight Time			06/02/2022 10:00:35 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	2023	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						05/31/2022	2023.01	05/31/2022 02:22:39 PM Mountain Daylight Time		05/26/2022 12:39:02 PM Mountain Daylight Time			05/31/2022 02:23:43 PM Mountain Daylight Time	SEQUOIA PACE, LLC	WelbeHealth Sequoia PACE	https://welbehealth.com/locations/	WelbeHealth Sequoia PACE (PACE)	08	20		1			H2384	001	0	2023	Parts of Fresno, Kings, Madera and Tulare Counties		2		2			2									https://www.carekinesis.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						05/31/2022	2023.01	05/31/2022 02:22:52 PM Mountain Daylight Time		05/26/2022 12:39:02 PM Mountain Daylight Time			05/31/2022 02:23:43 PM Mountain Daylight Time	SEQUOIA PACE, LLC	WelbeHealth Sequoia PACE	https://welbehealth.com/locations/	WelbeHealth Sequoia PACE (PACE)	08	20		1			H2384	002	0	2023	Parts of Fresno, Kings, Madera and Tulare Counties		2		2			2									https://www.carekinesis.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						06/01/2022	2023.01	06/01/2022 01:08:12 PM Eastern Daylight Time		05/27/2022 02:48:21 PM Eastern Daylight Time			06/01/2022 01:11:16 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	2023	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						06/01/2022	2023.01	06/01/2022 01:09:17 PM Eastern Daylight Time		05/27/2022 02:47:42 PM Eastern Daylight Time			06/01/2022 01:11:16 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	2023	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				08/02/2022	2023.01	08/02/2022 12:00:45 PM Central Daylight Time	08/01/2022 10:51:31 PM Central Daylight Time	07/29/2022 05:27:25 PM Central Daylight Time			08/03/2022 09:30:14 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	2023	Central and East Kansas		2		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	1	01	7c;7i;	
H2392	003	0	1	01	01	H2392_003_0	5	1		1				08/02/2022	2023.01	08/02/2022 12:02:32 PM Central Daylight Time	08/01/2022 10:53:21 PM Central Daylight Time	07/29/2022 05:28:00 PM Central Daylight Time			08/03/2022 09:30:14 AM Central Daylight Time	KANSAS SUPERIOR SELECT, INC.	Kansas Health Advantage	KansasHealthAdvantage.com	Kansas Health Advantage Choice (HMO I-SNP)	01	01		1			H2392	003	0	2023	Central and East Kansas		2		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	1	01	7c;7i;	
H2400	001	0	1	01	01	H2400_001_0	4	1		1				06/03/2022	2023.01	06/03/2022 08:07:54 PM India Standard Time	08/03/2022 11:07:29 AM Eastern Daylight Time	08/03/2022 11:07:29 AM Eastern Daylight Time			08/03/2022 11:09:01 AM 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	2023	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				05/30/2022	2023.01	05/30/2022 07:46:37 PM India Standard Time	08/03/2022 11:07:29 AM Eastern Daylight Time	08/03/2022 11:07:29 AM Eastern Daylight Time			08/03/2022 11:09:01 AM 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	2023	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	08/15/2022	2023.01	08/15/2022 11:08:52 AM Central Daylight Time	08/03/2022 10:52:49 AM Central Daylight Time	07/31/2022 01:37:21 AM Central Daylight Time			08/15/2022 04:08:01 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2406	001	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:14:20 AM Central Daylight Time	08/03/2022 10:53:28 AM Central Daylight Time	07/31/2022 01:37:45 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	008	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:14:34 AM Central Daylight Time	08/03/2022 10:54:08 AM Central Daylight Time	07/31/2022 01:38:09 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	009	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:15:09 AM Central Daylight Time	08/03/2022 10:54:49 AM Central Daylight Time	07/31/2022 01:38:33 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	010	0	2023	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			
H2406	011	0	1	04	01	H2406_011_0	2	1					1	08/03/2022	2023.01	08/03/2022 09:15:39 AM Central Daylight Time	08/03/2022 10:55:28 AM Central Daylight Time	07/31/2022 01:38:58 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	011	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:16:21 AM Central Daylight Time	08/03/2022 10:56:08 AM Central Daylight Time	07/31/2022 01:39:21 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	012	0	2023	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	08/03/2022	2023.01	08/03/2022 09:16:46 AM Central Daylight Time	08/03/2022 10:56:49 AM Central Daylight Time	07/31/2022 01:39:46 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	013	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:17:20 AM Central Daylight Time	08/03/2022 10:57:30 AM Central Daylight Time	07/31/2022 01:40:10 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	014	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:18:20 AM Central Daylight Time	08/03/2022 10:58:09 AM Central Daylight Time	07/31/2022 01:40:34 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	015	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:18:44 AM Central Daylight Time	08/03/2022 10:58:50 AM Central Daylight Time	07/31/2022 01:40:58 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	016	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:18:55 AM Central Daylight Time	08/03/2022 10:59:29 AM Central Daylight Time	07/31/2022 01:41:22 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	017	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:19:24 AM Central Daylight Time	08/03/2022 11:00:10 AM Central Daylight Time	07/31/2022 01:41:46 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	018	0	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 09:19:53 AM Central Daylight Time	08/03/2022 11:00:50 AM Central Daylight Time	07/31/2022 01:42:10 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	019	0	2023	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						06/03/2022	2023.01	06/03/2022 09:28:01 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	805	0	2023	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	06/03/2022	2023.01	06/03/2022 09:29:20 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	806	0	2023	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						06/03/2022	2023.01	06/03/2022 09:29:45 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	807	0	2023	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						06/03/2022	2023.01	06/03/2022 09:30:15 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	808	0	2023	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	06/03/2022	2023.01	06/03/2022 09:32:13 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	809	0	2023	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						06/03/2022	2023.01	06/03/2022 09:32:47 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	810	0	2023	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						06/03/2022	2023.01	06/03/2022 09:33:13 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	811	0	2023	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						06/03/2022	2023.01	06/03/2022 09:33:38 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	812	0	2023	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						06/03/2022	2023.01	06/03/2022 09:34:04 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	813	0	2023	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	06/03/2022	2023.01	06/03/2022 09:34:27 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	814	0	2023	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						06/03/2022	2023.01	06/03/2022 09:35:15 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	815	0	2023	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						06/03/2022	2023.01	06/03/2022 09:36:37 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	816	0	2023	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	06/03/2022	2023.01	06/03/2022 09:37:04 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	817	0	2023	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						06/03/2022	2023.01	06/03/2022 09:38:14 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	818	0	2023	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						06/03/2022	2023.01	06/03/2022 09:38:45 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	819	0	2023	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						06/03/2022	2023.01	06/03/2022 09:39:07 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	820	0	2023	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	06/03/2022	2023.01	06/03/2022 09:40:57 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	821	0	2023	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						06/03/2022	2023.01	06/03/2022 09:41:22 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	822	0	2023	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						06/03/2022	2023.01	06/03/2022 09:41:44 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	823	0	2023	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						06/03/2022	2023.01	06/03/2022 09:42:06 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	824	0	2023	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						06/03/2022	2023.01	06/03/2022 09:42:28 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	825	0	2023	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						06/03/2022	2023.01	06/03/2022 09:43:03 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	826	0	2023	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						06/03/2022	2023.01	06/03/2022 09:43:26 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	827	0	2023	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						06/03/2022	2023.01	06/03/2022 09:43:47 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	828	0	2023	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	06/03/2022	2023.01	06/03/2022 09:44:10 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	829	0	2023	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						06/03/2022	2023.01	06/03/2022 09:44:34 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	830	0	2023	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						06/03/2022	2023.01	06/03/2022 09:44:59 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	831	0	2023	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						06/03/2022	2023.01	06/03/2022 09:45:20 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	832	0	2023	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						06/03/2022	2023.01	06/03/2022 09:45:49 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	833	0	2023	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						06/03/2022	2023.01	06/03/2022 09:46:13 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	834	0	2023	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						06/03/2022	2023.01	06/03/2022 09:46:34 AM Central Daylight Time					06/03/2022 03:16:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	835	0	2023	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	15	1	2	1			0	07/11/2022	2023.01	07/11/2022 10:29:48 AM Central Daylight Time	08/01/2022 10:46:39 AM Central Daylight Time	08/01/2022 11:23:17 AM Central Daylight Time			08/01/2022 12:22:26 PM 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	2023	Northern, west central, and southwestern Minnesota		2		2			1	3		1					1	https://primewest.org/pharmacy-search	https://primewest.org/drug-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	8	1	2	1			0	07/12/2022	2023.01	07/12/2022 09:46:07 AM Central Daylight Time	08/01/2022 11:54:29 AM Central Daylight Time	08/01/2022 11:46:24 AM Central Daylight Time			08/01/2022 12:07:23 PM 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	2023	Itasca County		2		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	9	1	2	1			0	07/13/2022	2023.01	07/13/2022 04:46:22 PM Central Daylight Time	08/01/2022 12:55:28 PM Central Daylight Time	08/01/2022 01:08:26 PM Central Daylight Time			08/01/2022 01:22:14 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	2023	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	1		0	07/15/2022	2023.01	07/15/2022 12:52:21 PM Central Daylight Time	08/01/2022 11:15:51 AM Central Daylight Time	08/01/2022 08:44:30 AM Central Daylight Time			08/05/2022 01:46:39 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/msho	HealthPartners Minnesota Senior Health Options (HMO D-SNP)	01	01		1			H2422	002	0	2023	Minneapolis/St. Paul Metro Area		2		2			1	3		1					1	healthpartners.com/msho	healthpartners.com/medicarerx	healthpartners.com/msho	(888)820-4285		(952)967-7029		(877)713-8215		(952)883-5050		(888)820-4285		(952)967-7029		(877)713-8215		(952)883-5050		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2425	001	0	1	01	01	H2425_001_0	6	1	2	1			0	08/03/2022	2023.01	08/03/2022 06:34:01 PM Central Daylight Time	08/04/2022 01:35:04 PM Central Daylight Time	07/31/2022 01:21:48 PM Central Daylight Time			08/04/2022 04:32:53 PM Central Daylight Time	HMO Minnesota	Blue Plus	www.bluecrossmn.com/secureblue	SecureBlue (HMO D-SNP)	01	01		1			H2425	001	0	2023	87 Counties within the State of Minnesota		2		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	3	1						06/02/2022	2023.01	06/02/2022 11:54:24 AM Central Daylight Time		08/03/2022 09:03:23 AM Central Daylight Time			08/03/2022 09:49:52 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Basic w/Rx 2 (Cost)	06	18		1			H2450	001	0	2023	Select Counties in MN		2	17590	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	3	1						06/02/2022	2023.01	06/02/2022 11:53:26 AM Central Daylight Time		08/03/2022 09:03:33 AM Central Daylight Time			08/03/2022 09:49:52 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Enhanced w/Rx 2 (Cost)	06	18		1			H2450	002	0	2023	Select Counties in MN		2	17382	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						06/02/2022	2023.01	06/02/2022 11:50:13 AM Central Daylight Time		08/03/2022 09:03:38 AM Central Daylight Time			08/03/2022 09:49:52 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Thrift w/Rx (Cost)	06	18		1			H2450	007	0	2023	All of SD, select MN, ND, and WI counties		2	3282	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	3	1						06/02/2022	2023.01	06/02/2022 11:48:47 AM Central Daylight Time		08/03/2022 09:03:44 AM Central Daylight Time			08/03/2022 09:49:52 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Basic w/Rx (Cost)	06	18		1			H2450	016	0	2023	Select Counties in MN		2	39113	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	05/25/2022	2023.01	05/25/2022 10:38:30 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Thrift (Cost)	06	18		1			H2450	030	0	2023	All SD plus counties in IA KS MN MO ND NE OK WI WY		2	4775	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 10:39:46 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Basic (Cost)	06	18		1			H2450	032	0	2023	Select Counties in MN		2	49129	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 10:41:56 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Enhanced (Cost)	06	18		1			H2450	033	0	2023	Select Counties in MN		2	14142	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 10:44:37 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	06	18		1			H2450	034	0	2023	All of SD, plus select counties in ND and WY		2	305303	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	3	1						06/02/2022	2023.01	06/02/2022 11:47:20 AM Central Daylight Time		08/03/2022 09:03:52 AM Central Daylight Time			08/03/2022 09:49:52 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core w/Rx (Cost)	06	18		1			H2450	035	0	2023	All of SD, plus select counties in ND		2	34630	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 10:49:32 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	036	0	2023	All of SD, plus select counties in ND and WY		2	126877	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	3	1						06/02/2022	2023.01	06/02/2022 11:45:40 AM Central Daylight Time		08/03/2022 09:04:00 AM Central Daylight Time			08/03/2022 09:49:52 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier w/Rx (Cost)	06	18		1			H2450	037	0	2023	All of SD, plus select counties in ND		2	9718	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 10:54:30 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Focus (Cost)	06	18		1			H2450	038	0	2023	Select counties in WI		2	147406	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	3	1						06/02/2022	2023.01	06/02/2022 11:42:02 AM Central Daylight Time		08/03/2022 09:04:05 AM Central Daylight Time			08/03/2022 09:49:52 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Focus w/Rx (Cost)	06	18		1			H2450	039	0	2023	Select counties in WI		2	71280	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	06/02/2022	2023.01	06/02/2022 12:22:14 PM Central Daylight Time					06/02/2022 03:35:03 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Total (Cost)	06	18		1			H2450	040	0	2023	Select counties in WI		2	19307	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	3	1						06/02/2022	2023.01	06/02/2022 12:21:54 PM Central Daylight Time		08/03/2022 09:04:12 AM Central Daylight Time			08/03/2022 09:49:52 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Total w/Rx (Cost)	06	18		1			H2450	041	0	2023	Select counties in WI		2	14559	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 11:00:00 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	042	0	2023	Select counties in Iowa		2	2682	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 11:02:31 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	043	0	2023	Select counties in Nebraska		2	69428	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 11:04:02 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Standard (Cost)	06	18		1			H2450	044	0	2023	All of SD, select MN, ND, and NE counties		2	236276	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 11:06:24 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	06	18		1			H2450	045	0	2023	Select counties in IA		2	1130	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 11:09:14 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	06	18		1			H2450	046	0	2023	Select counties in NE		2	6475	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 11:11:49 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	06	18		1			H2450	047	0	2023	Select counties in KS, MO, and OK		2	75	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 11:19:42 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	048	0	2023	Select counties in KS, MO, and OK		2	2225	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	3	1						06/02/2022	2023.01	06/02/2022 11:39:20 AM Central Daylight Time		08/03/2022 09:04:23 AM Central Daylight Time			08/03/2022 09:49:52 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Standard w/Rx (Cost)	06	18		1			H2450	049	0	2023	SD and select counties in MN		2	15116	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	1	1				0	0	05/25/2022	2023.01	05/25/2022 11:21:03 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Standard (Cost)	06	18		1			H2450	050	0	2023	Select counties in WI		2	16878	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						05/25/2022	2023.01	05/25/2022 11:22:56 AM Central Daylight Time					05/27/2022 08:27:04 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Group Prime Solution w/Rx (Cost)	06	18		1			H2450	801	0	2023	All SD plus counties in IA KS MN MO ND NE OK WI WY		1	30000	2			2									medica.com/Members	medica.com/Members	medica.com/Members	(800)575-2330		(952)992-2330		(855)844-6395		(952)992-2345		(800)575-2330		(952)992-2330		(855)844-6395		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2456	002	0	1	01	01	H2456_002_0	8	1	2	1			0	08/10/2022	2023.01	08/10/2022 12:58:28 PM Central Daylight Time	08/04/2022 01:20:08 PM Central Daylight Time	08/03/2022 12:39:31 PM Central Daylight Time			08/10/2022 01:00:41 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	2023	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	6	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:13:40 PM Central Daylight Time	08/04/2022 02:09:34 PM Central Daylight Time	08/04/2022 02:05:56 PM Central Daylight Time			08/04/2022 02:19:55 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica DUAL Solution (HMO D-SNP)	01	01		1			H2458	002	0	2023	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	5	1				0	0	08/04/2022	2023.01	08/04/2022 01:28:40 PM Central Daylight Time	06/03/2022 11:48:59 AM Central Daylight Time				08/05/2022 10:41:26 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Value (HMO-POS)	01	02		1			H2459	001	0	2023	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	5	1					1	08/04/2022	2023.01	08/04/2022 01:35:53 PM Central Daylight Time	08/03/2022 12:24:24 PM Central Daylight Time	08/01/2022 03:56:03 PM Central Daylight Time			08/05/2022 10:41:26 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Prime (HMO-POS)	01	02		1			H2459	020	0	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 02:09:53 PM Central Daylight Time	08/03/2022 12:28:01 PM Central Daylight Time	08/01/2022 04:10:26 PM Central Daylight Time			08/05/2022 10:41:26 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Classic (HMO-POS)	01	02		1			H2459	021	1	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 02:01:42 PM Central Daylight Time	08/03/2022 12:30:37 PM Central Daylight Time	08/01/2022 04:27:15 PM Central Daylight Time			08/05/2022 10:41:26 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Classic (HMO-POS)	01	02		1			H2459	021	2	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 02:09:25 PM Central Daylight Time	08/03/2022 01:12:00 PM Central Daylight Time	08/01/2022 04:43:55 PM Central Daylight Time			08/05/2022 10:41:26 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Classic (HMO-POS)	01	02		1			H2459	021	3	2023	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	4	1					1	07/13/2022	2023.01	07/13/2022 02:08:15 PM Central Daylight Time	08/03/2022 01:13:58 PM Central Daylight Time	08/01/2022 05:00:03 PM Central Daylight Time			08/05/2022 10:52:00 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Essentials Rx (HMO-POS)	01	02		1			H2459	023	1	2023	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	4	1					1	07/13/2022	2023.01	07/13/2022 02:51:17 PM Central Daylight Time	08/03/2022 01:15:57 PM Central Daylight Time	08/01/2022 05:12:13 PM Central Daylight Time			08/05/2022 10:52:00 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Essentials Rx (HMO-POS)	01	02		1			H2459	023	2	2023	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	4	1					1	07/13/2022	2023.01	07/13/2022 02:20:53 PM Central Daylight Time	08/03/2022 01:19:09 PM Central Daylight Time	08/01/2022 05:24:13 PM Central Daylight Time			08/05/2022 10:52:00 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Standard (HMO-POS)	01	02		1			H2459	024	0	2023	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	3	1					1	07/13/2022	2023.01	07/13/2022 02:30:42 PM Central Daylight Time	08/03/2022 01:20:53 PM Central Daylight Time	08/01/2022 05:37:19 PM Central Daylight Time			08/05/2022 10:52:00 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Complete (HMO-POS)	01	02		1			H2459	026	1	2023	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	4	1					1	07/13/2022	2023.01	07/13/2022 02:33:51 PM Central Daylight Time	08/03/2022 01:22:42 PM Central Daylight Time	08/01/2022 05:51:49 PM Central Daylight Time			08/05/2022 10:52:00 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Complete (HMO-POS)	01	02		1			H2459	026	3	2023	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	07/13/2022	2023.01	07/13/2022 02:35:58 PM Central Daylight Time	08/03/2022 01:24:53 PM Central Daylight Time	08/01/2022 06:04:27 PM Central Daylight Time			08/05/2022 11:01:54 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Complete (HMO-POS)	01	02		1			H2459	026	4	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 02:16:07 PM Central Daylight Time	08/03/2022 01:28:20 PM Central Daylight Time	08/01/2022 06:16:44 PM Central Daylight Time			08/05/2022 11:01:54 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Prime (HMO-POS)	01	02		1			H2459	028	0	2023	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	4	1					1	07/13/2022	2023.01	07/13/2022 09:59:11 AM Central Daylight Time	08/03/2022 01:30:28 PM Central Daylight Time	08/01/2022 06:28:14 PM Central Daylight Time			08/05/2022 11:01:54 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Aware (HMO-POS)	01	02		1			H2459	029	0	2023	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	5	1				0	0	08/04/2022	2023.01	08/04/2022 02:18:46 PM Central Daylight Time	06/03/2022 11:54:02 AM Central Daylight Time				08/05/2022 11:01:54 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Value Plus (HMO-POS)	01	02		1			H2459	030	0	2023	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	5	1		1			1	07/13/2022	2023.01	07/13/2022 07:51:05 AM Central Daylight Time	08/03/2022 01:43:18 PM Central Daylight Time	08/01/2022 06:40:43 PM Central Daylight Time			08/05/2022 11:01:54 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Advocate Choice (HMO I-SNP)	01	01		1			H2459	031	0	2023	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	(877)523-1515		(612)676-3600		(877)671-1065		(612)676-6652		(877)523-1515		(612)676-3600		(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	5	1		1			1	07/13/2022	2023.01	07/13/2022 07:52:36 AM Central Daylight Time	08/03/2022 01:47:20 PM Central Daylight Time	08/01/2022 07:01:11 PM Central Daylight Time			08/05/2022 11:01:54 AM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Advocate Plus (HMO I-SNP)	01	01		1			H2459	032	0	2023	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	(877)523-1515		(612)676-3600		(877)671-1065		(612)676-6652		(877)523-1515		(612)676-3600		(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	801	0	1	02	01	H2459_801_0	1	1						05/27/2022	2023.01	05/27/2022 07:38:28 AM Central Daylight Time					06/06/2022 09:25:46 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	Group UCare (HMO-POS)	01	02		1			H2459	801	0	2023	Minnesota and 26 Wisconsin Counties		1	72009	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)598-6574		(612)676-6900		(877)447-4385		(612)676-6840		(877)598-6574		(612)676-6900		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2461	005	0	1	18	06	H2461_005_0	4	1				0	0	09/01/2022	2023.01	09/01/2022 12:15:26 PM Central Daylight Time					09/01/2022 01:23:37 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Core Plan (Cost)	06	18		1			H2461	005	0	2023	21 County region		2	40285	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	5	1				0	0	09/01/2022	2023.01	09/01/2022 12:16:11 PM Central Daylight Time					09/01/2022 01:23:37 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Choice Plan (Cost)	06	18		1			H2461	006	0	2023	21 County Region		2	148502	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	4	1				0	0	09/01/2022	2023.01	09/01/2022 12:17:47 PM Central Daylight Time					09/01/2022 01:23:37 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Complete Plan (Cost)	06	18		1			H2461	007	0	2023	21 County region		2	189818	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	4	1						09/01/2022	2023.01	09/01/2022 12:18:38 PM Central Daylight Time		07/31/2022 01:23:48 PM Central Daylight Time			09/01/2022 01:23:37 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Core Plan with Rx (Cost)	06	18		1			H2461	008	0	2023	21 County Region		2	8602	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	5	1						09/01/2022	2023.01	09/01/2022 12:19:36 PM Central Daylight Time		07/31/2022 01:25:48 PM Central Daylight Time			09/01/2022 01:23:37 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Choice Plan with Rx (Cost)	06	18		1			H2461	009	0	2023	21 County Region		2	112002	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	4	1						09/01/2022	2023.01	09/01/2022 12:27:02 PM Central Daylight Time		07/31/2022 01:27:48 PM Central Daylight Time			09/01/2022 01:23:37 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Complete Plan with Rx (Cost)	06	18		1			H2461	010	0	2023	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	022	0	1	18	06	H2462_022_0	4	1				0	0	06/01/2022	2023.01	06/01/2022 10:18:41 PM Central Daylight Time					06/03/2022 05:42:16 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Base (Cost)	06	18		1			H2462	022	0	2023	Select Counties in ND and SD		2	24	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	6	1				0	0	07/15/2022	2023.01	07/15/2022 02:04:55 PM Central Daylight Time					07/15/2022 02:10:23 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Plains (Cost)	06	18		1			H2462	023	0	2023	Select Counties in ND and SD		2	1788	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	6	1				0	0	07/15/2022	2023.01	07/15/2022 02:05:14 PM Central Daylight Time					07/15/2022 02:10:23 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Prairie (Cost)	06	18		1			H2462	024	0	2023	Select Counties in ND and SD		2	13872	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	7	1				0	0	08/01/2022	2023.01	08/01/2022 12:54:41 PM Central Daylight Time					08/01/2022 02:32:17 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Crest (Cost)	06	18		1			H2462	025	0	2023	Select Counties in ND and SD		2	852	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	06/03/2022	2023.01	06/03/2022 04:55:57 PM Central Daylight Time					06/03/2022 10:48:19 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Basic WI (Cost)	06	18		1			H2462	026	0	2023	Select Counties in Western WI		2	432	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	5	1				0	0	08/01/2022	2023.01	08/01/2022 12:55:19 PM Central Daylight Time					08/01/2022 02:32:17 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital WI (Cost)	06	18		1			H2462	027	0	2023	Select Counties in Western WI		2	8124	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	4	1				0	0	08/01/2022	2023.01	08/01/2022 12:55:47 PM Central Daylight Time					08/01/2022 02:32:17 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance WI (Cost)	06	18		1			H2462	028	0	2023	Select Counties in Western WI		2	11988	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	029	0	1	18	06	H2462_029_0	7	1				0	0	07/15/2022	2023.01	07/15/2022 02:06:58 PM Central Daylight Time					07/15/2022 02:10:23 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Valley (Cost)	06	18		1			H2462	029	0	2023	Select Counties in ND and SD		2	7476	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	801	0	1	18	06	H2462_801_0	1	1						05/26/2022	2023.01	05/26/2022 08:39:55 AM Central Daylight Time					06/03/2022 02:41:48 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	2023	Select Counties in 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)-																
H2462	802	0	1	18	06	H2462_802_0	1	1						05/26/2022	2023.01	05/26/2022 08:40:14 AM Central Daylight Time					06/03/2022 02:41:48 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	2023	Select Counties in 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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:11:07 PM Eastern Daylight Time	08/03/2022 04:02:06 PM Eastern Daylight Time	07/30/2022 06:27:26 AM Eastern Daylight Time			08/04/2022 03:15:16 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	2023	Pinal and Yuma Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2463	003	0	1	01	01	H2463_003_0	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:38:05 PM Eastern Daylight Time	08/03/2022 04:20:14 PM Eastern Daylight Time	07/30/2022 06:27:50 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H2463-003 (HMO)	01	01		1			H2463	003	0	2023	Maricopa		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2478	001	0	1	01	01	H2478_001_0	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 12:17:50 PM Pacific Daylight Time	08/04/2022 05:57:02 PM Pacific Daylight Time	08/01/2022 10:29:24 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF NEVADA INC	Molina Healthcare of Nevada	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H2478	001	0	2023	Select counties in Nevada		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			
H2478	002	0	1	01	01	H2478_002_0	9	1					1	08/04/2022	2023.01	08/04/2022 12:18:23 PM Pacific Daylight Time	08/04/2022 05:57:30 PM Pacific Daylight Time	08/01/2022 10:29:56 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF NEVADA INC	Molina Healthcare of Nevada	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H2478	002	0	2023	Select counties in Nevada		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			
H2478	003	0	1	01	01	H2478_003_0	8	1					1	08/04/2022	2023.01	08/04/2022 12:19:09 PM Pacific Daylight Time	08/04/2022 05:58:00 PM Pacific Daylight Time	08/01/2022 03:26:02 PM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF NEVADA INC	Molina Healthcare of Nevada	www.molinahealthcare.com/medicare	Molina Medicare Choice Care Select (HMO)	01	01		1			H2478	003	0	2023	Select counties in Nevada		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			
H2486	003	0	1	01	01	H2486_003_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 11:13:55 AM Eastern Daylight Time	08/03/2022 03:43:40 PM Eastern Daylight Time	07/30/2022 06:28:14 AM Eastern Daylight Time			08/04/2022 11:06:38 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H2486-003 (HMO)	01	01		1			H2486	003	0	2023	Select Counties in UT		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 11:15:30 AM Eastern Daylight Time	08/03/2022 03:55:27 PM Eastern Daylight Time	07/30/2022 06:28:40 AM Eastern Daylight Time			08/04/2022 11:06:38 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H2486	005	0	2023	Select Counties in ID		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 03:02:50 PM Eastern Daylight Time	08/03/2022 03:52:50 PM Eastern Daylight Time	07/30/2022 06:29:04 AM Eastern Daylight Time			08/04/2022 12:37:53 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	2023	Snohomish County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 03:03:08 PM Eastern Daylight Time	08/03/2022 03:53:45 PM Eastern Daylight Time	07/30/2022 06:29:30 AM Eastern Daylight Time			08/04/2022 12:37:53 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	2023	Clark County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/21/2022	2023.01	07/21/2022 04:32:09 PM Eastern Daylight Time	08/03/2022 03:56:44 PM Eastern Daylight Time	07/30/2022 06:29:54 AM Eastern Daylight Time			08/04/2022 11:06:38 AM 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	2023	Select Counties in Idaho		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	009	0	1	01	01	H2486_009_0	2	1			1		1	08/01/2022	2023.01	08/01/2022 11:03:07 AM Eastern Daylight Time	08/03/2022 04:03:34 PM Eastern Daylight Time	07/30/2022 06:30:20 AM Eastern Daylight Time			08/04/2022 11:15:24 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H2486-009 (HMO)	01	01		1			H2486	009	0	2023	Select Counties in OR		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/27/2022	2023.01	05/27/2022 04:22:43 PM Eastern Daylight Time					05/27/2022 04:31:30 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	801	0	2023	Select counties in Utah		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 04:24:26 PM Eastern Daylight Time					05/27/2022 04:31:30 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	802	0	2023	Select counties in Utah		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/27/2022	2023.01	05/27/2022 04:27:32 PM Eastern Daylight Time					05/27/2022 04:31:30 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	805	0	2023	Select counties in Utah		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 04:30:33 PM Eastern Daylight Time					05/27/2022 04:31:30 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	806	0	2023	Select counties in Utah		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 08:42:17 AM Pacific Daylight Time	08/03/2022 08:09:50 PM Eastern Daylight Time	07/30/2022 08:48:09 AM Eastern Daylight Time			08/04/2022 05:10:27 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	2023	Select counties in HI		2		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	007	0	1	01	01	H2491_007_0	4	1						08/03/2022	2023.01	08/03/2022 02:08:46 PM Eastern Daylight Time	08/03/2022 08:09:31 PM Eastern Daylight Time	07/30/2022 08:48:41 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in LA		2		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	009	0	1	01	01	H2491_009_0	4	1						08/03/2022	2023.01	08/03/2022 03:32:53 PM Eastern Daylight Time	08/03/2022 08:11:00 PM Eastern Daylight Time	07/30/2022 08:49:13 AM Eastern Daylight Time			08/04/2022 05:10:27 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	2023	Select counties in HI		2		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;7k;16b;17a;18a;	
H2491	010	0	1	01	01	H2491_010_0	4	1						06/01/2022	2023.01	06/01/2022 05:30:21 PM Eastern Daylight Time	08/03/2022 08:10:29 PM Eastern Daylight Time	07/30/2022 08:49:44 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H2491	010	0	2023	Select counties in LA		2		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	5	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 07:15:51 PM Pacific Daylight Time	08/03/2022 08:11:30 PM Eastern Daylight Time	07/30/2022 08:50:16 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Freedom Access (HMO D-SNP)	01	01		1			H2491	011	0	2023	Select counties in LA		2		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	5	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 07:14:23 PM Pacific Daylight Time	08/03/2022 08:12:28 PM Eastern Daylight Time	07/30/2022 08:50:48 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Pinnacle Liberty (HMO D-SNP)	01	01		1			H2491	012	0	2023	Select counties in LA		2		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	015	0	1	01	01	H2491_015_0	4	1						08/03/2022	2023.01	08/03/2022 03:34:28 PM Eastern Daylight Time	08/03/2022 08:12:09 PM Eastern Daylight Time	07/30/2022 08:51:20 AM Eastern Daylight Time			08/04/2022 05:10:27 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	2023	Select counties in HI		2		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						08/03/2022	2023.01	08/03/2022 02:21:47 PM Eastern Daylight Time	08/03/2022 08:13:27 PM Eastern Daylight Time	07/30/2022 08:51:51 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Endurance (HMO)	01	01		1			H2491	016	0	2023	Select counties in LA		2		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						08/01/2022	2023.01	08/01/2022 03:53:03 PM Eastern Daylight Time	08/03/2022 08:14:25 PM Eastern Daylight Time	07/30/2022 08:52:22 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in LA		2		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	05/26/2022	2023.01	05/26/2022 03:12:08 PM Pacific Daylight Time	06/03/2022 08:12:57 PM Eastern Daylight Time				07/15/2022 04:06:59 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	2023	Select counties in LA		2		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			
H2491	019	0	1	01	01	H2491_019_0	4	1						08/01/2022	2023.01	08/01/2022 03:56:29 PM Eastern Daylight Time	08/03/2022 08:15:23 PM Eastern Daylight Time	07/30/2022 08:52:54 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H2491	019	0	2023	Select Counties in Louisiana		2		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	020	0	1	01	01	H2491_020_0	4	1						08/01/2022	2023.01	08/01/2022 04:02:00 PM Eastern Daylight Time	08/03/2022 08:16:20 PM Eastern Daylight Time	07/30/2022 08:53:26 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H2491	020	0	2023	Select Counties in Louisiana		2		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	021	0	1	01	01	H2491_021_0	4	1						08/01/2022	2023.01	08/01/2022 04:07:16 PM Eastern Daylight Time	08/03/2022 08:17:19 PM Eastern Daylight Time	07/30/2022 08:53:57 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H2491	021	0	2023	Select Counties in Louisiana		2		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	022	0	1	01	01	H2491_022_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 08:19:28 AM Pacific Daylight Time	08/03/2022 08:18:19 PM Eastern Daylight Time	07/30/2022 08:54:29 AM Eastern Daylight Time			08/04/2022 05:26:29 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	022	0	2023	Select Counties in Louisiana		2		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			
H2506	001	0	1	48	05	H2506_001_0	5	1						07/11/2022	2023.01	07/11/2022 12:43:11 PM Central Daylight Time					07/11/2022 12:44:56 PM Central Daylight Time	Aetna Better Health Premier Plan MMAI Inc.	Aetna Better Health Premier Plan	www.aetnabetterhealth.com/illinois	Aetna Better Health Premier Plan MMAI (Medicare-Medicaid Plan)	05	48		1			H2506	001	0	2023	Illinois statewide		2	228000	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)-																
H2509	001	0	1	02	01	H2509_001_0	3	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 09:07:50 AM Central Daylight Time	08/03/2022 11:11:47 AM Central Daylight Time	07/31/2022 01:42:35 AM Central Daylight Time			08/12/2022 09:10:55 AM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP)	01	02		1			H2509	001	0	2023	Select counties in Florida		2		2			1	3		1					1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2526	001	0	1	04	01	H2526_001_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:02:24 PM US Eastern Daylight Time	08/04/2022 09:38:47 AM Eastern Daylight Time	07/31/2022 01:41:41 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO INC	Devoted Health	www.Devoted.com	Devoted CHOICE Ohio (PPO)	01	04		1			H2526	001	0	2023	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			
H2531	001	0	1	48	05	H2531_001_0	3	1						07/14/2022	2023.01	07/14/2022 11:03:00 AM Central Daylight Time					07/20/2022 10:55:56 AM Central 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	2023	Select Counties in Ohio		2		2			2									www.optumrx.com	www.uhccommunityplan.com	www.uhccommunityplan.com	(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2533	001	0	1	48	05	H2533_001_0	2	1						10/27/2022	2023.01	10/27/2022 12:55:50 PM Pacific Daylight Time					10/27/2022 03:23:04 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	2023	South Carolina		2		2			2									www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)735-5831		(855)735-5831		(855)701-4887		(855)701-4887		(855)735-5831		(855)735-5831		(855)701-4887		(855)701-4887		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2537	001	0	1	20	08	H2537_001_0	1	1						06/03/2022	2023.01	06/03/2022 12:08:37 PM Eastern Daylight Time		06/02/2022 02:13:14 PM Eastern Daylight Time			06/03/2022 12:18:01 PM Eastern Daylight Time	SPIRITRUST LUTHERAN LIFE	SpiriTrust Lutheran LIFE	www.spiritrustlutheranlife.org	SpiriTrust Lutheran LIFE - Dual (PACE)	08	20		1			H2537	001	0	2023	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	1	1						06/03/2022	2023.01	06/03/2022 12:09:02 PM Eastern Daylight Time		06/02/2022 02:15:38 PM Eastern Daylight Time			06/03/2022 12:18:01 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	2023	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																
H2541	001	0	1	20	08	H2541_001_0	1	1						03/21/2023	2023.01	03/21/2023 01:10:27 PM Pacific Daylight Time		03/15/2023 10:12:43 AM Pacific Daylight Time			03/21/2023 01:12:23 PM Pacific Daylight Time	AGEWELL PACE	AgeWell PACE	N/A	AgeWell PACE (PACE)	08	20		1			H2541	001	0	2023	Counties: Sonoma & Marin		2		2			2									N/A	N/A												(707)615-4437				(707)615-4437												(707)615-4437				(707)615-6955																
H2541	002	0	1	20	08	H2541_002_0	1	1						03/21/2023	2023.01	03/21/2023 01:10:53 PM Pacific Daylight Time		03/15/2023 10:12:50 AM Pacific Daylight Time			03/21/2023 01:12:23 PM Pacific Daylight Time	AGEWELL PACE	AgeWell PACE	N/A	AgeWell PACE Medicare Only (PACE)	08	20		1			H2541	002	0	2023	Counties: Sonoma & Marin		2		2			2									N/A	N/A												(707)615-4437				(707)615-4437												(707)615-4437				(707)615-6955																
H2563	004	0	1	01	01	H2563_004_0	10	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 11:27:39 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 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	2023	State of Virginia		2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	005	1	1	01	01	H2563_005_1	9	1			1		0	08/03/2022	2023.01	08/03/2022 11:27:57 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	01	01		1			H2563	005	1	2023	Greater Hampton Roads Area	Greater Hampton Roads Area - Southside	2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	005	2	1	01	01	H2563_005_2	9	1			1		0	08/03/2022	2023.01	08/03/2022 11:28:11 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	01	01		1			H2563	005	2	2023	Greater Hampton Roads Area	Greater Hampton Roads Area - Peninsula	2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	008	0	1	01	01	H2563_008_0	9	1			1		1	08/03/2022	2023.01	08/03/2022 11:46:56 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	008	0	2023	Northern Virginia		2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	009	0	1	01	01	H2563_009_0	10	1			1		1	08/03/2022	2023.01	08/03/2022 11:47:11 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	009	0	2023	Central Virginia		2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	014	0	1	01	01	H2563_014_0	8	1				0	0	07/07/2022	2023.01	07/07/2022 11:20:48 AM Eastern Daylight Time	07/14/2022 01:52:00 PM Eastern Daylight Time				07/14/2022 01:59:23 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Salute (HMO)	01	01		1			H2563	014	0	2023	Virginia		2		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)828-1120		(711)-		(800)828-1120		(711)-										2					2					2	2			
H2563	015	0	1	01	01	H2563_015_0	9	1			1		1	08/03/2022	2023.01	08/03/2022 11:47:25 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimhealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	015	0	2023	Southwest Virginia		2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	016	0	1	01	01	H2563_016_0	9	1			1		1	08/03/2022	2023.01	08/03/2022 11:47:39 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	016	0	2023	Roanoke/ Alleghany and surrounding counties		2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	017	1	1	01	01	H2563_017_1	9	1			1		1	08/03/2022	2023.01	08/03/2022 11:48:20 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	017	1	2023	Greater Hampton Roads Area	Greater Hampton Roads Area - Southside	2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	017	2	1	01	01	H2563_017_2	9	1			1		1	08/03/2022	2023.01	08/03/2022 11:48:33 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	017	2	2023	Greater Hampton Roads Area	Greater Hampton Roads Area - Peninsula	2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	018	0	1	01	01	H2563_018_0	8	1		1	1		1	08/03/2022	2023.01	08/03/2022 11:48:56 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Engage - Diabetes and Heart (HMO C-SNP)	01	01		1			H2563	018	0	2023	Greater Hampton Roads Area		2		2			1	4			00000000000000000010000					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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	019	0	1	01	01	H2563_019_0	9	1			2		0	08/03/2022	2023.01	08/03/2022 11:47:54 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Savings (HMO)	01	01		1			H2563	019	0	2023	Greater Hampton Roads Area		2		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	801	0	1	01	01	H2563_801_0	5	1						05/31/2022	2023.01	05/31/2022 09:34:46 AM Eastern Daylight Time					06/06/2022 04:04:20 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	2023	Nationwide		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	802	0	1	01	01	H2563_802_0	5	1						05/23/2022	2023.01	05/23/2022 10:59:47 AM Eastern Daylight Time					06/06/2022 04:04:20 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	2023	Nationwide		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)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		(800)828-1120		(711)-		2					2					2	2			
H2563	803	0	1	01	01	H2563_803_0	5	1				0	0	05/23/2022	2023.01	05/23/2022 11:01:17 AM Eastern Daylight Time					06/06/2022 04:04:20 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	2023	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)828-1120		(711)-		(800)828-1120		(711)-										2					2					2	2			
H2563	804	0	1	01	01	H2563_804_0	5	1				0	0	05/23/2022	2023.01	05/23/2022 11:03:00 AM Eastern Daylight Time					06/06/2022 04:04:20 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	2023	Nationwide		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)828-1120		(711)-		(800)828-1120		(711)-										2					2					2	2			
H2577	001	1	1	04	01	H2577_001_1	2	1					1	08/02/2022	2023.01	08/02/2022 01:42:09 PM Central Daylight Time	08/03/2022 10:40:30 AM Central Daylight Time	07/31/2022 01:42:59 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	001	1	2023	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	08/02/2022	2023.01	08/02/2022 01:48:06 PM Central Daylight Time	08/03/2022 10:41:07 AM Central Daylight Time	07/31/2022 01:43:23 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	001	2	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 01:52:15 PM Central Daylight Time	08/03/2022 10:41:45 AM Central Daylight Time	07/31/2022 01:43:47 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2577	002	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 01:57:38 PM Central Daylight Time	08/03/2022 10:42:22 AM Central Daylight Time	07/31/2022 01:44:11 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Rebate (PPO)	01	04		1			H2577	003	1	2023	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	2	1					1	08/03/2022	2023.01	08/03/2022 11:03:44 AM Central Daylight Time	08/03/2022 10:43:00 AM Central Daylight Time	07/31/2022 01:44:35 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Rebate (PPO)	01	04		1			H2577	003	2	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 10:10:43 AM Central Daylight Time	08/03/2022 10:43:39 AM Central Daylight Time	07/31/2022 01:44:59 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	004	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 10:13:35 AM Central Daylight Time	08/03/2022 10:44:20 AM Central Daylight Time	07/31/2022 01:45:23 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Rebate (PPO)	01	04		1			H2577	005	0	2023	State of 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	2	1					1	08/04/2022	2023.01	08/04/2022 10:33:38 AM Central Daylight Time	08/03/2022 10:44:59 AM Central Daylight Time	07/31/2022 01:45:48 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	006	0	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 11:52:51 AM Central Daylight Time	08/03/2022 10:45:39 AM Central Daylight Time	07/31/2022 01:46:12 AM Central Daylight Time			08/04/2022 04:00:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2577	007	0	2023	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	08/03/2022	2023.01	08/03/2022 11:37:08 AM Central Daylight Time	08/03/2022 10:46:18 AM Central Daylight Time	07/31/2022 01:46:36 AM Central Daylight Time			08/04/2022 04:00:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2577	008	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 10:17:09 AM Central Daylight Time	08/03/2022 10:46:56 AM Central Daylight Time	07/31/2022 01:47:00 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	009	0	2023	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	08/02/2022	2023.01	08/02/2022 10:23:30 AM Central Daylight Time	08/03/2022 10:47:34 AM Central Daylight Time	07/31/2022 01:47:24 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	011	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 02:07:05 PM Central Daylight Time	08/03/2022 10:48:15 AM Central Daylight Time	07/31/2022 01:47:48 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	013	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 10:27:15 AM Central Daylight Time	08/03/2022 10:48:53 AM Central Daylight Time	07/31/2022 01:48:12 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	014	0	2023	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	1	1				0	0	05/31/2022	2023.01	05/31/2022 11:00:21 AM Central Daylight Time	06/01/2022 11:16:54 AM Central Daylight Time				06/02/2022 01:35:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2577	015	0	2023	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	08/02/2022	2023.01	08/02/2022 11:38:45 AM Central Daylight Time	08/03/2022 10:49:32 AM Central Daylight Time	07/31/2022 01:48:36 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	016	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:43:30 AM Central Daylight Time	08/03/2022 10:50:12 AM Central Daylight Time	07/31/2022 01:49:00 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	017	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:47:07 AM Central Daylight Time	08/03/2022 10:50:52 AM Central Daylight Time	07/31/2022 01:49:24 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	018	0	2023	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	1	1				0	0	06/01/2022	2023.01	06/01/2022 02:44:20 PM Central Daylight Time	06/01/2022 11:19:23 AM Central Daylight Time				06/02/2022 01:35:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2577	019	0	2023	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	08/03/2022	2023.01	08/03/2022 11:39:03 AM Central Daylight Time	08/03/2022 10:51:31 AM Central Daylight Time	07/31/2022 01:49:48 AM Central Daylight Time			08/04/2022 04:00:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Medicare Advantage Choice (PPO)	01	04		1			H2577	020	0	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 12:56:02 PM Central Daylight Time	08/03/2022 10:52:10 AM Central Daylight Time	07/31/2022 01:50:13 AM Central Daylight Time			08/04/2022 04:40:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	021	0	2023	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			
H2577	022	0	1	04	01	H2577_022_0	2	1					1	08/02/2022	2023.01	08/02/2022 02:10:03 PM Central Daylight Time	08/03/2022 10:52:49 AM Central Daylight Time	07/31/2022 01:50:37 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	022	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 02:13:01 PM Central Daylight Time	08/03/2022 10:53:28 AM Central Daylight Time	07/31/2022 01:51:01 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	023	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 10:30:39 AM Central Daylight Time	08/03/2022 10:54:07 AM Central Daylight Time	07/31/2022 01:51:25 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	026	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 10:35:37 AM Central Daylight Time	08/03/2022 10:54:46 AM Central Daylight Time	07/31/2022 01:51:50 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	027	0	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 12:56:14 PM Central Daylight Time	08/03/2022 10:55:27 AM Central Daylight Time	07/31/2022 01:52:14 AM Central Daylight Time			08/04/2022 04:40:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	028	0	2023	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			
H2577	029	0	1	04	01	H2577_029_0	2	1					1	08/04/2022	2023.01	08/04/2022 12:56:27 PM Central Daylight Time	08/03/2022 10:56:06 AM Central Daylight Time	07/31/2022 01:52:38 AM Central Daylight Time			08/04/2022 04:40:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	029	0	2023	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			
H2577	030	0	1	04	01	H2577_030_0	4	1					1	08/02/2022	2023.01	08/02/2022 11:55:25 AM Central Daylight Time	08/03/2022 10:56:45 AM Central Daylight Time	07/31/2022 01:53:02 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	030	0	2023	Brunswick		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2577	031	0	1	04	01	H2577_031_0	4	1					1	08/02/2022	2023.01	08/02/2022 12:42:48 PM Central Daylight Time	08/03/2022 10:57:24 AM Central Daylight Time	07/31/2022 01:53:26 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	031	0	2023	Brunswick		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(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	02	01	H2582_002_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:45:19 PM Central Daylight Time	08/03/2022 11:59:27 AM Central Daylight Time	07/31/2022 01:53:51 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Rocky Mountain Health Plans	www.rmhpdualcare.org	Rocky Mountain Health Plans DualCare Plus (HMO-POS D-SNP)	01	02		1			H2582	002	0	2023	Select Counties in Western Colorado		2		2			1	3		1					1	www.rmhpdualcare.org	www.rmhpdualcare.org	www.rmhpdualcare.org	(833)420-2075		(833)420-2075		(888)834-3721		(888)834-3721		(833)420-2075		(833)420-2075		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2582	004	0	1	02	01	H2582_004_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 11:00:21 AM Central Daylight Time	08/03/2022 12:00:43 PM Central Daylight Time	07/31/2022 01:54:15 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Rocky Mountain Health Plans	www.rmhpMedicare.org	Rocky Mountain Health Plans CareAdvantage Value (HMO-POS)	01	02		1			H2582	004	0	2023	Select Counties in Western Colorado		2		2			2									www.rmhpMedicare.org	www.rmhpMedicare.org	www.rmhpMedicare.org	(888)282-1420		(888)282-1420		(800)555-5757		(800)555-5757		(888)282-1420		(888)282-1420		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2582	005	0	1	02	01	H2582_005_0	2	1			2		1	05/31/2022	2023.01	05/31/2022 10:59:56 PM Central Daylight Time	08/03/2022 12:01:58 PM Central Daylight Time	07/31/2022 01:54:39 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Rocky Mountain Health Plans	www.rmhpMedicare.org	Rocky Mountain Health Plans CareAdvantage Enhanced (HMO-POS)	01	02		1			H2582	005	0	2023	Select Counties in Western Colorado		2		2			2									www.rmhpMedicare.org	www.rmhpMedicare.org	www.rmhpMedicare.org	(888)282-1420		(888)282-1420		(800)555-5757		(800)555-5757		(888)282-1420		(888)282-1420		(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	2	1				0	0	04/27/2022	2023.01	04/27/2022 09:12:26 AM Central Daylight Time					06/03/2022 08:35:36 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer PPO (PPO)	01	04		1			H2591	801	0	2023	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;9b;10a;11a;11b;15;	1	2;	1									
H2591	802	0	1	04	01	H2591_802_0	2	1						04/27/2022	2023.01	04/27/2022 09:12:55 AM Central Daylight Time					06/03/2022 08:35:36 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare (PPO)	01	04		1			H2591	802	0	2023	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;9b;10a;11a;11b;15;	1	2;	1									
H2591	803	0	1	04	01	H2591_803_0	2	1						04/27/2022	2023.01	04/27/2022 09:13:26 AM Central Daylight Time					06/03/2022 08:35:36 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare (non calendar) (PPO)	01	04		1			H2591	803	0	2023	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;9b;10a;11a;11b;15;	1	2;	1									
H2593	001	0	1	01	01	H2593_001_0	5	1			2		0	08/01/2022	2023.01	08/01/2022 05:00:41 PM Eastern Daylight Time	08/04/2022 06:22:57 PM Eastern Daylight Time	08/04/2022 06:41:49 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H2593	001	0	2023	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	5	1		1	2		0	08/01/2022	2023.01	08/01/2022 05:00:58 PM Eastern Daylight Time	08/04/2022 06:22:58 PM Eastern Daylight Time	08/04/2022 06:41:52 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Comfort (HMO I-SNP)	01	01		1			H2593	003	0	2023	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	5	1		1	2		0	08/01/2022	2023.01	08/01/2022 05:02:26 PM Eastern Daylight Time	08/04/2022 06:23:00 PM Eastern Daylight Time	08/04/2022 06:41:54 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage Lung Care (HMO C-SNP)	01	01		1			H2593	005	0	2023	Pima County		2		2			1	4			00000000000100000000000					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	5	1		1	2		0	08/01/2022	2023.01	08/01/2022 05:04:42 PM Eastern Daylight Time	08/04/2022 06:23:01 PM Eastern Daylight Time	08/04/2022 06:41:57 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Diabetes Care (HMO C-SNP)	01	01		1			H2593	006	0	2023	Pima County		2		2			1	4			00000010000000000000000					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	5	1		1	2		0	08/01/2022	2023.01	08/01/2022 05:06:08 PM Eastern Daylight Time	08/04/2022 06:23:02 PM Eastern Daylight Time	08/04/2022 06:42:00 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Heart Care (HMO C-SNP)	01	01		1			H2593	013	0	2023	Pima County		2		2			1	4			00000000000000010000000					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	019	0	1	01	01	H2593_019_0	5	1		1	2		0	08/01/2022	2023.01	08/01/2022 05:07:01 PM Eastern Daylight Time	08/04/2022 06:23:04 PM Eastern Daylight Time	08/04/2022 06:42:02 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Comfort (HMO I-SNP)	01	01		1			H2593	019	0	2023	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	5	1	2	1	1		0	07/11/2022	2023.01	07/11/2022 04:19:50 PM Eastern Daylight Time	08/04/2022 06:16:36 PM Eastern Daylight Time	08/04/2022 06:29:42 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	8	1			2		0	09/23/2022	2023.01	09/23/2022 03:52:34 PM Eastern Daylight Time	08/04/2022 06:16:37 PM Eastern Daylight Time	08/04/2022 06:29:45 PM Eastern Daylight Time			09/27/2022 09:23:05 AM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H2593	022	0	2023	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	5	1			2		0	07/14/2022	2023.01	07/14/2022 01:27:33 PM Pacific Daylight Time	08/04/2022 03:19:47 PM Pacific Daylight Time	08/04/2022 03:35:48 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H2593	029	0	2023	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	6	1		1	2		0	08/02/2022	2023.01	08/02/2022 12:38:05 AM Pacific Daylight Time		08/04/2022 03:35:50 PM Pacific Daylight Time		08/04/2022 03:19:49 PM Pacific Daylight Time	08/19/2022 08:29:30 AM 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	2023	Select Counties in Texas		2		2			1	4			00000000100000000000000					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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:19:01 AM Eastern Daylight Time	08/04/2022 06:15:21 PM Eastern Daylight Time	08/04/2022 06:27:21 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1		1	2		1	07/14/2022	2023.01	07/14/2022 01:27:57 PM Pacific Daylight Time	08/04/2022 03:19:50 PM Pacific Daylight Time	08/04/2022 03:35:53 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Harris County		2		2			1	4			00000010000000000000000					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	6	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:29:11 PM Pacific Daylight Time	08/04/2022 03:19:51 PM Pacific Daylight Time	08/04/2022 03:35:56 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Harris County		2		2			1	4			00000000000000010000000					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	5	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:29:24 PM Pacific Daylight Time	08/04/2022 03:19:53 PM Pacific Daylight Time	08/04/2022 03:35:58 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Harris County		2		2			1	4			00000000000100000000000					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	08/01/2022	2023.01	08/01/2022 05:08:42 PM Eastern Daylight Time		08/04/2022 06:42:05 PM Eastern Daylight Time		08/04/2022 06:23:05 PM Eastern Daylight Time	08/19/2022 10:01:22 AM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage ESRD Care (HMO C-SNP)	01	01		1			H2593	040	0	2023	Pima County		2		2			1	4			00000000100000000000000					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	5	1		1	2		1	08/02/2022	2023.01	08/02/2022 01:16:41 AM Pacific Daylight Time	08/04/2022 03:19:54 PM Pacific Daylight Time	08/04/2022 03:36:01 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Tarrant County		2		2			1	4			00000010000000000000000					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	5	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:29:50 PM Pacific Daylight Time	08/04/2022 03:19:56 PM Pacific Daylight Time	08/04/2022 03:36:04 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Comfort (HMO I-SNP)	01	01		1			H2593	042	0	2023	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	6	1		1	2		0	08/02/2022	2023.01	08/02/2022 12:41:38 AM Pacific Daylight Time		08/04/2022 03:36:06 PM Pacific Daylight Time		08/04/2022 03:19:57 PM Pacific Daylight Time	08/19/2022 08:29:30 AM 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	2023	Select Counties in TX		2		2			1	4			00000000100000000000000					www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6823		(844)469-6823		(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			
H2610	005	0	1	01	01	H2610_005_0	4	1						08/03/2022	2023.01	08/03/2022 10:08:55 AM Central Daylight Time	08/03/2022 05:03:01 PM Central Daylight Time	08/03/2022 05:07:31 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	005	0	2023	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	5	1						08/03/2022	2023.01	08/03/2022 10:09:41 AM Central Daylight Time	08/03/2022 02:49:11 PM Central Daylight Time	08/03/2022 02:52:54 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	01	01		1			H2610	006	0	2023	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	5	1						08/03/2022	2023.01	08/03/2022 10:10:20 AM Central Daylight Time	08/03/2022 02:41:34 PM Central Daylight Time	08/03/2022 02:44:37 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	011	0	2023	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	5	1					0	08/03/2022	2023.01	08/03/2022 10:10:35 AM Central Daylight Time	08/03/2022 02:56:48 PM Central Daylight Time	08/03/2022 05:15:58 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	015	0	2023	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		(855)941-0562		(314)209-3930		(866)597-9560		(314)209-2700		(855)941-0562		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	016	0	1	01	01	H2610_016_0	5	1						08/03/2022	2023.01	08/03/2022 10:17:11 AM Central Daylight Time	08/03/2022 02:52:51 PM Central Daylight Time	08/03/2022 02:57:34 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Select (HMO)	01	01		1			H2610	016	0	2023	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	7	1	2	1			0	08/03/2022	2023.01	08/03/2022 10:22:53 AM Central Daylight Time	08/03/2022 03:43:53 PM Central Daylight Time	08/03/2022 03:34:59 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Dual Advantage (HMO D-SNP)	01	01		1			H2610	017	0	2023	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	019	0	1	01	01	H2610_019_0	6	1					1	08/04/2022	2023.01	08/04/2022 08:56:18 AM Central Daylight Time	08/03/2022 03:53:04 PM Central Daylight Time	08/03/2022 04:03:23 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	019	0	2023	Little Rock Metropolitan Area		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6054		(877)218-6054		(855)425-0457		(855)425-0457		(877)218-6054		(877)218-6054		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	020	0	1	01	01	H2610_020_0	6	1					1	08/04/2022	2023.01	08/04/2022 08:56:37 AM Central Daylight Time	08/03/2022 04:17:31 PM Central Daylight Time	08/03/2022 04:26:57 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	01	01		1			H2610	020	0	2023	Little Rock Metropolitan Area		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6054		(877)218-6054		(855)425-0457		(855)425-0457		(877)218-6054		(877)218-6054		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	021	0	1	01	01	H2610_021_0	6	1					1	08/04/2022	2023.01	08/04/2022 08:56:59 AM Central Daylight Time	08/03/2022 03:50:05 PM Central Daylight Time	08/03/2022 04:05:31 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	021	0	2023	Lexington and Louisville Metropolitan Areas		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)294-0872		(877)294-0872		(855)425-0457		(855)425-0457		(877)294-0872		(877)294-0872		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	022	0	1	01	01	H2610_022_0	6	1					1	08/04/2022	2023.01	08/04/2022 08:57:23 AM Central Daylight Time	08/03/2022 03:54:01 PM Central Daylight Time	08/03/2022 04:10:59 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	01	01		1			H2610	022	0	2023	Lexington and Louisville Metropolitan Areas		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)294-0872		(877)294-0872		(855)425-0457		(855)425-0457		(877)294-0872		(877)294-0872		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	023	0	1	01	01	H2610_023_0	6	1					1	08/03/2022	2023.01	08/03/2022 10:24:31 AM Central Daylight Time	08/03/2022 03:59:36 PM Central Daylight Time	08/03/2022 04:16:18 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	023	0	2023	KY- Boone, Campbell, Grant and Kenton counties		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	024	0	1	01	01	H2610_024_0	6	1					1	08/03/2022	2023.01	08/03/2022 10:24:48 AM Central Daylight Time	08/03/2022 02:53:22 PM Central Daylight Time	08/03/2022 05:23:37 PM Central Daylight Time			08/04/2022 09:52:54 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	01	01		1			H2610	024	0	2023	KY- Boone, Campbell, Grant and Kenton counties		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	803	0	1	01	01	H2610_803_0	2	1						05/26/2022	2023.01	05/26/2022 03:22:22 PM Central Daylight Time					06/06/2022 03:26:12 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD Calendar Year (HMO)	01	01		1			H2610	803	0	2023	MO, IL, AR, KY and IN Service Areas		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	2	1						05/26/2022	2023.01	05/26/2022 03:24:40 PM Central Daylight Time					06/06/2022 03:26:12 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD non-Calendar Year (HMO)	01	01		1			H2610	804	0	2023	MO, IL, AR, KY and IN Service Areas		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	2	1				0	0	05/26/2022	2023.01	05/26/2022 03:42:02 PM Central Daylight Time					06/06/2022 03:26:12 PM 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	2023	MO, IL, AR, KY and IN Service Areas		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;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	2	1				0	0	05/26/2022	2023.01	05/26/2022 03:46:28 PM Central Daylight Time					06/06/2022 03:26:12 PM 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	2023	MO, IL, AR, KY and IN Service Areas		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						05/26/2022	2023.01	05/26/2022 03:47:05 PM Central Daylight Time					06/06/2022 03:26:12 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	2023	MO, IL, AR, KY and IN Service Areas		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						05/26/2022	2023.01	05/26/2022 03:48:20 PM Central Daylight Time					06/06/2022 03:26:12 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	2023	MO, IL, AR, KY and IN Service Areas		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	05/26/2022	2023.01	05/26/2022 03:49:54 PM Central Daylight Time					06/06/2022 03:26:12 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	2023	MO, IL, AR, KY and IN Service Areas		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	05/26/2022	2023.01	05/26/2022 03:51:31 PM Central Daylight Time					06/06/2022 03:26:12 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	2023	MO, IL, AR, KY and IN Service Areas		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	8	1		1			1	08/10/2022	2023.01	08/10/2022 09:44:13 AM Central Daylight Time	08/04/2022 01:14:14 PM Central Daylight Time	08/01/2022 12:35:04 PM Central Daylight Time			08/10/2022 09:45:08 AM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.htanc.com	HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)	01	01		1			H2624	001	0	2023	Triad: Alamance, Guilford, Randolph and Rockingham		2		2			1	4								www.htanc.com	www.htanc.com	www.htanc.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	2			
H2663	002	0	1	01	01	H2663_002_0	4	1						07/11/2022	2023.01	07/11/2022 04:37:24 PM Central Daylight Time	08/02/2022 01:20:53 PM Central Daylight Time	07/31/2022 08:37:06 PM Central Daylight Time			08/04/2022 10:17:20 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	2023	Missouri/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	2			
H2663	005	0	1	01	01	H2663_005_0	2	1						05/31/2022	2023.01	05/31/2022 08:09:06 PM Central Daylight Time	08/02/2022 01:21:55 PM Central Daylight Time	07/31/2022 08:37:30 PM Central Daylight Time			08/04/2022 10:17:20 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	2023	Metro St Louis - Missouri/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	2			
H2663	006	0	1	02	01	H2663_006_0	3	1						08/02/2022	2023.01	08/02/2022 05:51:17 PM Central Daylight Time	08/02/2022 01:23:01 PM Central Daylight Time	07/31/2022 08:37:56 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	Missouri/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	2			
H2663	017	0	1	01	01	H2663_017_0	4	1						08/10/2022	2023.01	08/10/2022 02:13:38 PM Central Daylight Time	08/02/2022 01:24:01 PM Central Daylight Time	07/31/2022 08:38:22 PM Central Daylight Time			08/10/2022 02:25:56 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	2023	Peoria and Tazewell 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	2			
H2663	021	0	1	02	01	H2663_021_0	2	1						08/02/2022	2023.01	08/02/2022 01:18:17 PM Central Daylight Time	08/02/2022 04:31:03 PM Central Daylight Time	07/31/2022 08:38:48 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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	05/31/2022	2023.01	05/31/2022 08:10:20 PM Central Daylight Time	06/01/2022 12:20:57 PM Central Daylight Time				06/02/2022 02:49:43 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	2023	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						08/02/2022	2023.01	08/02/2022 01:19:10 PM Central Daylight Time	08/02/2022 04:33:24 PM Central Daylight Time	07/31/2022 08:39:12 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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	05/31/2022	2023.01	05/31/2022 08:11:04 PM Central Daylight Time	06/01/2022 12:22:54 PM Central Daylight Time				06/02/2022 02:49:43 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	2023	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						08/02/2022	2023.01	08/02/2022 01:31:49 PM Central Daylight Time	08/02/2022 04:35:37 PM Central Daylight Time	07/31/2022 08:39:38 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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						08/02/2022	2023.01	08/02/2022 01:21:19 PM Central Daylight Time	08/02/2022 04:36:51 PM Central Daylight Time	07/31/2022 08:40:02 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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						08/02/2022	2023.01	08/02/2022 01:22:22 PM Central Daylight Time	08/02/2022 04:37:52 PM Central Daylight Time	07/31/2022 08:40:28 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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						08/02/2022	2023.01	08/02/2022 01:40:28 PM Central Daylight Time	08/02/2022 01:25:04 PM Central Daylight Time	07/31/2022 08:40:54 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	Metro St Louis Surrounding Area-Missouri/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	2			
H2663	034	0	1	01	01	H2663_034_0	2	1			2			08/01/2022	2023.01	08/01/2022 05:57:33 PM Central Daylight Time	08/02/2022 01:21:50 PM Central Daylight Time	07/31/2022 08:41:18 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H2663	034	0	2023	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						08/02/2022	2023.01	08/02/2022 01:23:56 PM Central Daylight Time	08/02/2022 04:39:02 PM Central Daylight Time	07/31/2022 08:41:44 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	039	0	1	01	01	H2663_039_0	2	1						08/02/2022	2023.01	08/02/2022 01:24:34 PM Central Daylight Time	08/02/2022 04:40:08 PM Central Daylight Time	07/31/2022 08:42:10 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	040	0	1	01	01	H2663_040_0	2	1						08/02/2022	2023.01	08/02/2022 01:25:13 PM Central Daylight Time	08/02/2022 04:41:17 PM Central Daylight Time	07/31/2022 08:42:34 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	041	0	1	01	01	H2663_041_0	3	1			2			08/02/2022	2023.01	08/02/2022 01:47:52 PM Central Daylight Time	08/02/2022 01:26:09 PM Central Daylight Time	07/31/2022 08:43:00 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	Eastern/Central 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	042	0	1	01	01	H2663_042_0	2	1						08/02/2022	2023.01	08/02/2022 01:25:53 PM Central Daylight Time	08/02/2022 04:42:27 PM Central Daylight Time	07/31/2022 08:43:26 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	043	0	1	01	01	H2663_043_0	2	1						08/02/2022	2023.01	08/02/2022 01:26:36 PM Central Daylight Time	08/02/2022 04:43:30 PM Central Daylight Time	07/31/2022 08:43:52 PM Central Daylight Time			08/04/2022 09:45:21 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	805	0	1	01	01	H2663_805_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 10:07:15 AM Eastern Daylight Time					06/02/2022 03:00:57 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	2023	Missouri and Illinois		1	280	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H2663	810	0	1	01	01	H2663_810_0	1	1						05/30/2022	2023.01	05/30/2022 10:06:12 AM Eastern Daylight Time					06/02/2022 03:00:57 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	2023	Kansas, Missouri, Illinois		1	32000	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H2686	001	0	1	04	01	H2686_001_0	9	1					1	08/03/2022	2023.01	08/03/2022 12:54:57 PM US Eastern Daylight Time	08/04/2022 09:39:15 AM Eastern Daylight Time	07/31/2022 01:42:02 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Devoted Health	www.Devoted.com	Devoted CHOICE Hawaii (PPO)	01	04		1			H2686	001	0	2023	Honolulu 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			
H2686	002	0	1	04	01	H2686_002_0	9	1					1	07/21/2022	2023.01	07/21/2022 06:37:32 PM US Eastern Daylight Time	08/04/2022 09:39:39 AM Eastern Daylight Time	07/31/2022 01:42:24 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Devoted Health	www.Devoted.com	Devoted CHOICE PLUS Hawaii (PPO)	01	04		1			H2686	002	0	2023	Honolulu 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			
H2694	001	0	1	04	01	H2694_001_0	7	1					1	08/05/2022	2023.01	08/05/2022 02:50:11 PM Central Daylight Time	08/03/2022 04:35:06 PM Eastern Daylight Time	08/03/2022 04:30:38 PM Eastern Daylight Time			08/05/2022 10:26:27 PM Eastern Daylight Time	ETERNALHEALTH, INC.	eternalHealth	https://www.eternalhealth.com/	eternalHealth Freedom (PPO)	01	04		1			H2694	001	0	2023	Middlesex, Suffolk and Worcester Counties		2		2			2									https://www.optumrx.com/oe_rxexternal/pharmacy-locator?type=PDPClientPharmacy&var=MDETH122OE&infoid=	https://www.optumrx.com/oe_rxexternal/prescription-drug-list?type=PDPClientFormulary&var=X2022EXEGO&	www.eternalHealth.com	(800)680-4568		(617)684-2348		(800)831-0735		(800)831-0735		(800)891-6989		(800)891-6989		(800)840-5431		(800)840-5431		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2694	002	0	1	04	01	H2694_002_0	7	1						08/05/2022	2023.01	08/05/2022 02:56:15 PM Central Daylight Time	08/03/2022 04:35:38 PM Eastern Daylight Time	08/03/2022 04:30:59 PM Eastern Daylight Time			08/05/2022 10:20:18 PM Eastern Daylight Time	ETERNALHEALTH, INC.	eternalHealth	https://eternalhealth.com	eternalHealth Freedom Buyback (PPO)	01	04		1			H2694	002	0	2023	Middlesex, Suffolk, and Worcester Counties		2		2			2									https://www.optumrx.com/oe_rxexternal/pharmacy-locator?type=PDPClientPharmacy&var=MDETH122OE&infoid=	https://www.optumrx.com/oe_rxexternal/prescription-drug-list?type=PDPClientFormulary&var=X2022EXEGO&	www.eternalHealth.com	(800)680-4568		(800)680-4568		(800)321-0735		(800)831-0735		(800)891-6989		(800)891-6989		(800)893-9457		(800)893-9457		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2697	001	0	1	01	01	H2697_001_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 03:04:02 PM US Eastern Daylight Time	08/04/2022 09:45:31 AM Eastern Daylight Time	07/31/2022 01:42:45 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted CORE Ohio (HMO)	01	01		1			H2697	001	0	2023	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	10	1			2		1	08/03/2022	2023.01	08/03/2022 08:27:26 AM US Eastern Daylight Time	08/04/2022 09:46:01 AM Eastern Daylight Time	07/31/2022 01:43:07 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted PRIME Ohio (HMO)	01	01		1			H2697	002	0	2023	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	11	1			2		0	08/03/2022	2023.01	08/03/2022 03:04:19 PM US Eastern Daylight Time	08/04/2022 09:46:26 AM Eastern Daylight Time	07/31/2022 01:43:28 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted GIVEBACK Ohio (HMO)	01	01		1			H2697	003	0	2023	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	004	0	1	01	01	H2697_004_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 08:28:11 AM US Eastern Daylight Time	08/04/2022 09:40:03 AM Eastern Daylight Time	07/31/2022 01:43:50 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted CORE Ohio (HMO)	01	01		1			H2697	004	0	2023	Cincinnati, Dayton, and Lima		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	005	0	1	01	01	H2697_005_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 08:28:55 AM US Eastern Daylight Time	08/04/2022 09:40:28 AM Eastern Daylight Time	07/31/2022 01:44:11 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted PRIME Ohio (HMO)	01	01		1			H2697	005	0	2023	Cincinnati, Dayton, and Lima		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	006	0	1	01	01	H2697_006_0	11	1			2		0	08/03/2022	2023.01	08/03/2022 03:04:46 PM US Eastern Daylight Time	08/04/2022 09:40:55 AM Eastern Daylight Time	07/31/2022 01:44:33 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted GIVEBACK Ohio (HMO)	01	01		1			H2697	006	0	2023	Cincinnati, Dayton, and Lima		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	007	0	1	01	01	H2697_007_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 09:17:54 AM US Eastern Daylight Time	08/04/2022 09:41:23 AM Eastern Daylight Time	07/31/2022 01:44:54 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted CORE Ohio (HMO)	01	01		1			H2697	007	0	2023	Delaware, Madison, Morrow, Union 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			
H2697	008	0	1	01	01	H2697_008_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 09:18:20 AM US Eastern Daylight Time	08/04/2022 09:41:50 AM Eastern Daylight Time	07/31/2022 01:45:16 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted PRIME Ohio (HMO)	01	01		1			H2697	008	0	2023	Delaware, Madison, Morrow, Union 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			
H2697	009	0	1	01	01	H2697_009_0	11	1			2		0	08/03/2022	2023.01	08/03/2022 03:05:06 PM US Eastern Daylight Time	08/04/2022 09:42:18 AM Eastern Daylight Time	07/31/2022 01:45:37 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted GIVEBACK Ohio (HMO)	01	01		1			H2697	009	0	2023	Delaware, Madison, Morrow, Union 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			
H2697	010	0	1	01	01	H2697_010_0	10	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:19:30 AM US Eastern Daylight Time	08/04/2022 09:42:43 AM Eastern Daylight Time	07/31/2022 01:45:59 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Ohio - 1 (HMO D-SNP)	01	01		1			H2697	010	0	2023	Ohio		2		2			1	3		2					1	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	011	0	1	01	01	H2697_011_0	11	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:19:58 AM US Eastern Daylight Time	08/04/2022 09:43:11 AM Eastern Daylight Time	07/31/2022 01:46:20 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted DUAL Ohio - 2 (HMO D-SNP)	01	01		1			H2697	011	0	2023	Ohio		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			
H2715	001	0	1	01	01	H2715_001_0	7	1					1	08/04/2022	2023.01	08/04/2022 12:30:09 PM Pacific Daylight Time	08/04/2022 05:58:26 PM Pacific Daylight Time	08/01/2022 10:30:58 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF ILLINOIS INC	Molina Healthcare of Illinois	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H2715	001	0	2023	Select counties in Illinois		2		2			2									www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(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)-		2					2					2	2			
H2722	002	0	1	02	01	H2722_002_0	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:11:59 PM Central Daylight Time	08/03/2022 11:57:38 AM Central Daylight Time	08/01/2022 04:32:46 PM Central Daylight Time			08/03/2022 08:59:57 PM 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	2023	Northwest, Central, and 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2722	003	0	1	02	01	H2722_003_0	9	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 12:13:24 PM Central Daylight Time	08/03/2022 11:58:02 AM Central Daylight Time	08/01/2022 04:33:06 PM Central Daylight Time			08/03/2022 08:59:57 PM 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	2023	Northwest, Central, and 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2722	004	0	1	02	01	H2722_004_0	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:14:39 PM Central Daylight Time	08/03/2022 11:58:26 AM Central Daylight Time	08/01/2022 04:33:24 PM Central Daylight Time			08/03/2022 08:59:57 PM 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	2023	Northwest, Central, and 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2722	005	0	1	02	01	H2722_005_0	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:22:53 PM Central Daylight Time	08/03/2022 11:58:50 AM Central Daylight Time	08/01/2022 04:33:44 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN OF ARKANSAS, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage Giveback (HMO-POS)	01	02		1			H2722	005	0	2023	Northwest, Central, and 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2722	801	0	1	02	01	H2722_801_0	5	1						05/17/2022	2023.01	05/17/2022 02:09:32 PM Central Daylight Time					06/01/2022 03:31:58 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	2023	State of 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2737	001	0	1	04	01	H2737_001_0	4	1					1	08/04/2022	2023.01	08/04/2022 06:00:40 PM Eastern Daylight Time	08/05/2022 02:26:59 PM Eastern Daylight Time	08/05/2022 02:34:38 PM Eastern Daylight Time			08/05/2022 02:36:17 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	2023	Hampden, Hampshire, Franklin, Berkshire Counties		2		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	4	1					1	08/04/2022	2023.01	08/04/2022 06:00:23 PM Eastern Daylight Time	08/05/2022 02:26:59 PM Eastern Daylight Time	08/05/2022 02:34:38 PM Eastern Daylight Time			08/05/2022 02:36:17 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	2023	Hampden, Hampshire, Franklin, Berkshire Counties		2		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	1	1						06/06/2022	2023.01	06/06/2022 01:12:16 PM Eastern Daylight Time					06/06/2022 01:13:20 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	2023	United States		1	600	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	1	1				0	0	06/06/2022	2023.01	06/06/2022 01:08:12 PM Eastern Daylight Time					06/06/2022 01:13:20 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	2023	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	1	1						06/06/2022	2023.01	06/06/2022 01:09:47 PM Eastern Daylight Time					06/06/2022 01:13:20 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	2023	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	08/02/2022	2023.01	08/02/2022 07:09:50 PM Central Daylight Time	08/02/2022 04:09:34 PM Central Daylight Time	08/01/2022 10:31:17 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	CIGNA HEALTHCARE OF CONNECTICUT INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H2752	001	0	2023	Connecticut		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(877)646-7738		(877)646-7738		(800)668-3813		(800)668-3813		(877)646-7738		(877)646-7738		(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	06/01/2022	2023.01	06/01/2022 07:10:16 PM Central Daylight Time	08/02/2022 04:10:11 PM Central Daylight Time	08/01/2022 10:31:48 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	CIGNA HEALTHCARE OF CONNECTICUT INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H2752	002	0	2023	Connecticut		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(877)646-7738		(877)646-7738		(800)668-3813		(800)668-3813		(877)646-7738		(877)646-7738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2752	003	0	1	01	01	H2752_003_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 07:10:11 PM Central Daylight Time	08/02/2022 04:10:55 PM Central Daylight Time	08/01/2022 10:32:20 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	CIGNA HEALTHCARE OF CONNECTICUT INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Select Plus (HMO D-SNP)	01	01		1			H2752	003	0	2023	Connecticut		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(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	07/08/2022	2023.01	07/08/2022 01:45:16 PM Pacific Daylight Time	06/06/2022 10:48:31 AM Pacific Daylight Time				07/08/2022 03:35:11 PM Pacific Daylight Time	SUMMIT HEALTH PLAN, INC.	Summit Health Plan, Inc.	yoursummithealth.com	Summit Health Core (HMO-POS)	01	02		1			H2765	001	0	2023	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						08/04/2022	2023.01	08/04/2022 02:05:58 PM Pacific Daylight Time	08/04/2022 01:12:00 PM Pacific Daylight Time	08/02/2022 02:11:28 PM Pacific Daylight Time			08/04/2022 05:19:52 PM Pacific Daylight Time	SUMMIT HEALTH PLAN, INC.	Summit Health Plan, Inc.	yoursummithealth.com	Summit Health Value + Rx (HMO)	01	01		1			H2765	002	0	2023	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	8	1						08/05/2022	2023.01	08/05/2022 11:14:32 AM Pacific Daylight Time	08/04/2022 01:12:26 PM Pacific Daylight Time	08/02/2022 02:12:16 PM Pacific Daylight Time			08/05/2022 11:36:15 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	2023	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						08/04/2022	2023.01	08/04/2022 02:06:57 PM Pacific Daylight Time	08/04/2022 01:12:52 PM Pacific Daylight Time	08/02/2022 02:13:26 PM Pacific Daylight Time			08/04/2022 05:19:52 PM 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	2023	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	4	1						08/01/2022	2023.01	08/01/2022 02:17:03 PM Eastern Daylight Time	08/03/2022 07:29:16 PM Eastern Daylight Time	07/30/2022 08:55:01 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:31:43 PM Eastern Daylight Time	08/03/2022 07:30:24 PM Eastern Daylight Time	07/30/2022 08:55:33 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	109	0	1	04	01	H2775_109_0	4	1						08/03/2022	2023.01	08/03/2022 02:18:53 PM Eastern Daylight Time	08/03/2022 06:49:30 PM Central Daylight Time	07/30/2022 07:56:05 AM Central Daylight Time			08/04/2022 04:08:52 PM Central 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	2023	All counties in ME		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:38:25 PM Eastern Daylight Time	08/03/2022 07:31:33 PM Eastern Daylight Time	07/30/2022 08:56:36 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	1		0	08/03/2022	2023.01	08/03/2022 02:51:11 PM Eastern Daylight Time	08/03/2022 07:32:40 PM Eastern Daylight Time	07/30/2022 08:57:09 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	4	1						05/27/2022	2023.01	05/27/2022 03:29:16 PM Eastern Daylight Time	08/03/2022 07:33:47 PM Eastern Daylight Time	07/30/2022 08:57:40 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	4	1						07/14/2022	2023.01	07/14/2022 09:55:52 AM Central Daylight Time	08/03/2022 06:50:35 PM Central Daylight Time	07/30/2022 07:58:13 AM Central Daylight Time			08/04/2022 04:08:52 PM Central 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	2023	All counties in ME		2		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	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:58:11 AM Central Daylight Time	08/03/2022 06:51:44 PM Central Daylight Time	07/30/2022 07:58:46 AM Central Daylight Time			08/04/2022 04:08:52 PM Central 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	115	0	2023	All counties in ME		2		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	1	1				0	0	05/10/2022	2023.01	05/10/2022 10:45:53 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 10:40:59 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:14:05 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	13	1					1	08/05/2022	2023.01	08/05/2022 07:54:42 AM Pacific Daylight Time	08/05/2022 01:49:09 PM Pacific Daylight Time	08/05/2022 01:53:09 PM Pacific Daylight Time			08/05/2022 02:11:34 PM Pacific Daylight Time	WESTERN HEALTH ADVANTAGE	Western Health Advantage	medicare.westernhealth.com	Western Health Advantage MyCare (HMO)	01	01		1			H2782	002	0	2023	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	14	1					1	08/05/2022	2023.01	08/05/2022 07:54:55 AM Pacific Daylight Time	08/05/2022 01:53:58 PM Pacific Daylight Time	08/05/2022 01:55:01 PM Pacific Daylight Time			08/05/2022 02:11:34 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	2023	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	004	0	1	01	01	H2782_004_0	14	1					1	08/05/2022	2023.01	08/05/2022 07:55:08 AM Pacific Daylight Time	08/05/2022 01:57:00 PM Pacific Daylight Time	08/05/2022 01:57:43 PM Pacific Daylight Time			08/05/2022 02:11:34 PM Pacific Daylight Time	WESTERN HEALTH ADVANTAGE	Western Health Advantage	medicare.westernhealth.com	Western Health Advantage MyCare Compass (HMO)	01	01		1			H2782	004	0	2023	Humboldt		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	2	1				0	0	05/11/2022	2023.01	05/11/2022 09:10:46 AM Pacific Daylight Time					05/11/2022 09:21:24 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	2023	Northern California		1	1440	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;7g;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;7g;7i;7k;8a;8b1;8b2;8b3;18a;	1					1				
H2782	802	0	1	01	01	H2782_802_0	2	1						05/10/2022	2023.01	05/10/2022 03:08:00 PM Pacific Daylight Time					05/11/2022 09:21:24 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	2023	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;7g;7i;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;7g;7i;7k;8a;8b1;8b2;8b3;18a;	1					1				
H2782	803	0	1	01	01	H2782_803_0	2	1				0	0	05/10/2022	2023.01	05/10/2022 03:17:26 PM Pacific Daylight Time					05/11/2022 09:21:24 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	2023	Northern California		1	360	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;7g;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;7g;7i;7k;8a;8b1;8b2;8b3;18a;	1					1				
H2782	804	0	1	01	01	H2782_804_0	2	1						05/10/2022	2023.01	05/10/2022 03:23:00 PM Pacific Daylight Time					05/11/2022 09:21:24 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	2023	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;7g;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;7g;7i;7k;8a;8b1;8b2;8b3;18a;	1					1				
H2793	003	0	1	01	01	H2793_003_0	8	1					1	08/04/2022	2023.01	08/04/2022 03:36:02 PM Eastern Daylight Time	08/04/2022 03:47:34 PM Eastern Daylight Time	08/04/2022 02:21:27 PM Eastern Daylight Time			08/05/2022 09:39:28 AM Eastern Daylight Time	IMPERIAL INSURANCE COMPANIES INC.	Imperial Insurance Companies, Inc	www.imperialhealthplan.com	Imperial Insurance Company Traditional (HMO)	01	01		1			H2793	003	0	2023	AZ,TX,NV		2		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	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:21:46 PM Eastern Daylight Time	08/04/2022 03:47:57 PM Eastern Daylight Time	08/04/2022 02:22:01 PM Eastern Daylight Time			08/05/2022 09:39:28 AM Eastern 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	2023	TX		2		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	8	1		1			1	08/04/2022	2023.01	08/04/2022 03:36:20 PM Eastern Daylight Time	08/04/2022 03:48:19 PM Eastern Daylight Time	08/04/2022 02:22:30 PM Eastern Daylight Time			08/05/2022 09:39:28 AM Eastern 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	2023	AZ,TX,NV		2		2			1	4			00000000000000000010000					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	8	1					0	08/04/2022	2023.01	08/04/2022 03:38:40 PM Eastern Daylight Time	08/04/2022 03:48:41 PM Eastern Daylight Time	08/04/2022 02:23:12 PM Eastern Daylight Time			08/05/2022 09:39:28 AM Eastern Daylight Time	IMPERIAL INSURANCE COMPANIES INC.	Imperial Insurance Companies, Inc	www.imperialhealthplan.com	Imperial Insurance Traditional Plus (HMO)	01	01		1			H2793	007	0	2023	AZ, TX, NV		2		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			
H2793	008	0	1	01	01	H2793_008_0	7	1				0	0	07/13/2022	2023.01	07/13/2022 12:26:46 PM Eastern Daylight Time	06/06/2022 05:40:34 PM Eastern Daylight Time				07/13/2022 12:40:14 PM Eastern Daylight Time	IMPERIAL INSURANCE COMPANIES INC.	Imperial Insurance Companies, Inc	www.imperialhealthplan.com	Imperial Courage Plan (HMO)	01	01		1			H2793	008	0	2023	AZ, NV, TX		2		2			2									www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2802	001	0	1	02	01	H2802_001_0	4	1			2		1	08/05/2022	2023.01	08/05/2022 10:58:51 AM Central Daylight Time	08/03/2022 10:42:58 AM Central Daylight Time	07/31/2022 01:55:03 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	001	0	2023	Select Counties in Iowa and Nebraska		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	2			
H2802	007	0	1	02	01	H2802_007_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 10:58:49 AM Central Daylight Time	08/03/2022 10:43:32 AM Central Daylight Time	07/31/2022 01:55:27 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Profile (HMO-POS)	01	02		1			H2802	007	0	2023	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	08/03/2022	2023.01	08/03/2022 10:59:59 AM Central Daylight Time	08/03/2022 10:44:07 AM Central Daylight Time	07/31/2022 01:55:52 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	008	0	2023	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	08/03/2022	2023.01	08/03/2022 11:06:24 AM Central Daylight Time	08/03/2022 10:44:41 AM Central Daylight Time	07/31/2022 01:56:15 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	010	0	2023	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	08/03/2022	2023.01	08/03/2022 11:12:19 AM Central Daylight Time	08/03/2022 10:45:15 AM Central Daylight Time	07/31/2022 01:56:39 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	012	0	2023	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	08/03/2022	2023.01	08/03/2022 11:15:03 AM Central Daylight Time	08/03/2022 10:45:49 AM Central Daylight Time	07/31/2022 01:57:04 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	016	0	2023	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	08/03/2022	2023.01	08/03/2022 11:19:09 AM Central Daylight Time	08/03/2022 10:46:23 AM Central Daylight Time	07/31/2022 01:57:28 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	018	0	2023	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	024	0	1	02	01	H2802_024_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 11:19:50 AM Central Daylight Time	08/03/2022 10:46:57 AM Central Daylight Time	07/31/2022 01:57:52 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Access (HMO-POS)	01	02		1			H2802	024	0	2023	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	02	01	H2802_025_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 11:20:26 AM Central Daylight Time	08/03/2022 10:47:32 AM Central Daylight Time	07/31/2022 01:58:16 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H2802	025	0	2023	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	4	1		1	2		0	08/15/2022	2023.01	08/15/2022 11:09:06 AM Central Daylight Time	08/03/2022 10:48:06 AM Central Daylight Time	07/31/2022 01:58:40 AM Central Daylight Time			08/15/2022 04:16:54 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	2023	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	08/03/2022	2023.01	08/03/2022 04:14:20 PM Central Daylight Time	08/03/2022 10:48:39 AM Central Daylight Time	07/31/2022 01:59:04 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	08/03/2022	2023.01	08/03/2022 04:18:11 PM Central Daylight Time	08/03/2022 10:49:14 AM Central Daylight Time	07/31/2022 01:59:28 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	08/03/2022	2023.01	08/03/2022 04:24:29 PM Central Daylight Time	08/03/2022 10:49:48 AM Central Daylight Time	07/31/2022 01:59:53 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	08/03/2022	2023.01	08/03/2022 04:27:22 PM Central Daylight Time	08/03/2022 10:50:22 AM Central Daylight Time	07/31/2022 02:00:17 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	08/03/2022	2023.01	08/03/2022 04:33:03 PM Central Daylight Time	08/03/2022 10:50:56 AM Central Daylight Time	07/31/2022 02:00:41 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	08/03/2022	2023.01	08/03/2022 04:37:28 PM Central Daylight Time	08/03/2022 10:51:30 AM Central Daylight Time	07/31/2022 02:01:05 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	08/03/2022	2023.01	08/03/2022 04:41:34 PM Central Daylight Time	08/03/2022 10:52:04 AM Central Daylight Time	07/31/2022 02:01:29 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 1 (HMO-POS)	01	02		1			H2802	034	0	2023	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	08/03/2022	2023.01	08/03/2022 04:45:27 PM Central Daylight Time	08/03/2022 10:52:38 AM Central Daylight Time	07/31/2022 02:01:54 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 2 (HMO-POS)	01	02		1			H2802	035	0	2023	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	02	01	H2802_041_0	2	1			1		1	08/03/2022	2023.01	08/03/2022 11:40:54 AM Central Daylight Time	08/03/2022 10:53:11 AM Central Daylight Time	07/31/2022 02:02:18 AM Central Daylight Time			08/04/2022 04:00:41 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO-POS)	01	02		1			H2802	041	0	2023	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	02	01	H2802_044_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 11:57:49 AM Central Daylight Time	08/03/2022 10:53:44 AM Central Daylight Time	07/31/2022 02:02:43 AM Central Daylight Time			08/04/2022 04:00:41 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H2802	044	0	2023	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	02	01	H2802_048_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 04:48:47 PM Central Daylight Time	08/03/2022 10:54:18 AM Central Daylight Time	07/31/2022 02:03:07 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H2802	048	0	2023	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	08/03/2022	2023.01	08/03/2022 04:51:18 PM Central Daylight Time	08/03/2022 10:54:52 AM Central Daylight Time	07/31/2022 02:03:31 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	049	0	2023	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	1	1			2	0	0	06/02/2022	2023.01	06/02/2022 02:00:30 PM Central Daylight Time	06/01/2022 10:45:36 AM Central Daylight Time				06/02/2022 02:02:06 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	2023	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	08/03/2022	2023.01	08/03/2022 04:57:00 PM Central Daylight Time	08/03/2022 10:55:25 AM Central Daylight Time	07/31/2022 02:03:56 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	02	01	H2802_053_0	4	1	2	1	1		0	08/05/2022	2023.01	08/05/2022 10:58:57 AM Central Daylight Time	08/03/2022 10:55:59 AM Central Daylight Time	07/31/2022 02:04:20 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)	01	02		1			H2802	053	0	2023	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		(800)555-5757		(800)555-5757		(844)368-7149		(844)368-7149		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	054	0	1	02	01	H2802_054_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 11:21:33 AM Central Daylight Time	08/03/2022 10:56:32 AM Central Daylight Time	07/31/2022 02:04:44 AM Central Daylight Time			08/04/2022 02:55:03 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H2802	054	0	2023	Select counties in 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			
H2802	801	0	1	01	01	H2802_801_0	1	1						06/03/2022	2023.01	06/03/2022 09:46:59 AM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	801	0	2023	Select Counties in Alabama		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	802	0	1	01	01	H2802_802_0	1	1						06/03/2022	2023.01	06/03/2022 09:47:13 AM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	802	0	2023	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	06/03/2022	2023.01	06/03/2022 09:47:30 AM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	803	0	2023	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						06/03/2022	2023.01	06/03/2022 09:48:17 AM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	804	0	2023	St Louis Area		1	19884	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	06/03/2022	2023.01	06/03/2022 09:48:32 AM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	805	0	2023	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						06/03/2022	2023.01	06/03/2022 09:48:49 AM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	806	0	2023	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						06/03/2022	2023.01	06/03/2022 09:49:08 AM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	807	0	2023	Springfield Area		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	808	0	1	01	01	H2802_808_0	1	1				0	0	06/03/2022	2023.01	06/03/2022 09:49:24 AM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	808	0	2023	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						06/03/2022	2023.01	06/03/2022 09:49:41 AM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	809	0	2023	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				
H2802	816	0	1	01	01	H2802_816_0	2	1						06/17/2022	2023.01	06/17/2022 10:50:45 AM Central Daylight Time					06/17/2022 10:53:00 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	816	0	2023	KS		1	0	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	817	0	1	01	01	H2802_817_0	2	1				0	0	06/17/2022	2023.01	06/17/2022 10:51:10 AM Central Daylight Time					06/17/2022 10:53:00 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	817	0	2023	KS		1	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	818	0	1	01	01	H2802_818_0	2	1				0	0	06/17/2022	2023.01	06/17/2022 10:51:27 AM Central Daylight Time					06/17/2022 10:53:00 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	818	0	2023	KS		1	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	819	0	1	01	01	H2802_819_0	2	1						06/17/2022	2023.01	06/17/2022 10:51:52 AM Central Daylight Time					06/17/2022 10:53:00 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	819	0	2023	NE		1	0	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	820	0	1	01	01	H2802_820_0	2	1				0	0	06/17/2022	2023.01	06/17/2022 10:52:05 AM Central Daylight Time					06/17/2022 10:53:00 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	820	0	2023	NE		1	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	821	0	1	01	01	H2802_821_0	2	1				0	0	06/17/2022	2023.01	06/17/2022 10:52:21 AM Central Daylight Time					06/17/2022 10:53:00 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	821	0	2023	NE		1	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	822	0	1	01	01	H2802_822_0	1	1						06/03/2022	2023.01	06/03/2022 02:06:59 PM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	822	0	2023	IA		1	0	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		2					1				
H2802	823	0	1	01	01	H2802_823_0	1	1						06/03/2022	2023.01	06/03/2022 03:00:23 PM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	823	0	2023	IA		1	0	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		2					2				
H2802	824	0	1	01	01	H2802_824_0	1	1				0	0	06/03/2022	2023.01	06/03/2022 03:03:10 PM Central Daylight Time					06/03/2022 03:19:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	824	0	2023	IA		1	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;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		2					2				
H2815	001	0	1	20	08	H2815_001_0	1	1						06/01/2022	2023.01	06/01/2022 11:05:43 AM Mountain Daylight Time		06/01/2022 10:14:58 AM Mountain Daylight Time			06/01/2022 11:12:04 AM Mountain Daylight Time	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	08	20		1			H2815	001	0	2023	Montrose and Delta counties		2		2			2									www.voa.org	www.voa.org										(866)961-1451		(970)835-2900		(866)961-1451		(970)835-2900												(970)435-4018				(970)252-0522																
H2815	002	0	1	20	08	H2815_002_0	1	1						05/10/2022	2023.01	05/10/2022 10:36:12 AM Mountain Daylight Time		06/01/2022 10:15:07 AM Mountain Daylight Time			06/01/2022 11:12:04 AM Mountain Daylight Time	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	08	20		1			H2815	002	0	2023	Montrose and Delta counties		2		2			2									www.voa.org	www.voa.org										(866)961-1451		(970)964-3500		(866)961-1451		(970)252-0522												(970)435-4018				(970)252-0522																
H2816	013	0	1	09	04	H2816_013_0	4	1						08/03/2022	2023.01	08/03/2022 02:59:04 PM Eastern Daylight Time	08/03/2022 07:42:11 PM Eastern Daylight Time	07/30/2022 08:59:21 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	4	1						05/29/2022	2023.01	05/29/2022 02:18:55 PM Eastern Daylight Time	08/03/2022 07:54:31 PM Eastern Daylight Time	07/30/2022 08:59:53 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	3	1				0	0	06/03/2022	2023.01	06/03/2022 04:57:35 PM Eastern Daylight Time	06/03/2022 07:34:20 PM Eastern Daylight Time				07/15/2022 04:17:33 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	2023	Select counties in NY		2		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	3	1				0	0	05/29/2022	2023.01	05/29/2022 02:21:46 PM Eastern Daylight Time	06/03/2022 07:35:47 PM Eastern Daylight Time				07/15/2022 04:17:33 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	2023	Select counties in NY		2		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	4	1				0	0	05/29/2022	2023.01	05/29/2022 03:29:28 PM Eastern Daylight Time	06/03/2022 06:39:34 PM Central Daylight Time				07/15/2022 02:52:59 PM Central 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	2023	Select counties in ME		2		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	1	1				0	0	05/10/2022	2023.01	05/10/2022 10:46:32 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:14:15 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:14:21 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	6	1					1	08/03/2022	2023.01	08/03/2022 11:23:55 AM Central Daylight Time	08/02/2022 01:27:29 PM Central Daylight Time	08/02/2022 01:47:34 PM Central Daylight Time			08/04/2022 09:23:59 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	2023	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	8	1						07/11/2022	2023.01	07/11/2022 10:22:25 AM Central Daylight Time	08/02/2022 01:51:29 PM Central Daylight Time	08/02/2022 01:58:05 PM Central Daylight Time			08/04/2022 09:23:59 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	2023	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	7	1					1	08/03/2022	2023.01	08/03/2022 11:24:18 AM Central Daylight Time	08/02/2022 02:07:52 PM Central Daylight Time	08/02/2022 02:12:05 PM Central Daylight Time			08/04/2022 09:23:59 AM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.RiversideMedicareAdvantage.com	Riverside Medicare Advantage Complete (HMO)	01	01		1			H2825	003	0	2023	VA Peninsula, Williamsburg, Gloucester		2		2			2									www.RiversideMedicareAdvantage.com	www.RiversideMedicareAdvantage.com	www.RiversideMedicareAdvantage.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						05/10/2022	2023.01	05/10/2022 08:30:31 AM Central Daylight Time					06/02/2022 01:56:30 PM 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	2023	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						05/10/2022	2023.01	05/10/2022 08:31:51 AM Central Daylight Time					06/02/2022 01:56:30 PM 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	2023	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	05/10/2022	2023.01	05/10/2022 08:33:08 AM Central Daylight Time					06/02/2022 01:56:30 PM 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	2023	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;	2					1				
H2825	804	0	1	01	01	H2825_804_0	1	1				0	0	05/10/2022	2023.01	05/10/2022 08:34:15 AM Central Daylight Time					06/02/2022 01:56:30 PM 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	2023	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;	2					1				
H2835	001	0	1	20	08	H2835_001_0	1	1						06/06/2022	2023.01	06/06/2022 08:42:16 AM Eastern Daylight Time		06/06/2022 07:55:19 AM Eastern Daylight Time			06/06/2022 08:44:53 AM Eastern Daylight Time	THE CASCADE PACE, INC.	Thome PACE	www.thomepace.org	Thome PACE (PACE)	08	20		1			H2835	001	0	2023	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						06/06/2022	2023.01	06/06/2022 08:42:52 AM Eastern Daylight Time		06/06/2022 07:55:19 AM Eastern Daylight Time			06/06/2022 08:44:53 AM Eastern Daylight Time	THE CASCADE PACE, INC.	Thome PACE	www.thomepace.org	Thome PACE Medicare Only (PACE)	08	20		1			H2835	002	0	2023	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	7	1			2			06/02/2022	2023.01	06/02/2022 10:59:17 AM Eastern Daylight Time	08/04/2022 06:20:44 PM Eastern Daylight Time	08/04/2022 06:37:40 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:04:21 PM Eastern Daylight Time	08/04/2022 06:20:46 PM Eastern Daylight Time	08/04/2022 06:37:43 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	Select counties in Connecticut		2		2			1	3		1					1	shop.anthem.com/medicare	shop.anthem.com/medicare	www.anthem.com/medicare	(833)659-2531		(833)659-2531		(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	2	1						05/23/2022	2023.01	05/23/2022 02:13:21 PM Pacific Daylight Time					06/03/2022 10:20:54 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	2023	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;15;16b;18a;	2		1									
H2853	001	0	1	01	01	H2853_001_0	5	1						08/01/2022	2023.01	08/01/2022 12:39:20 PM Central Daylight Time	08/03/2022 08:35:57 PM Eastern Daylight Time	07/30/2022 09:00:25 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Saint Thomas Reward (HMO)	01	01		1			H2853	001	0	2023	Select counties in central Tennessee		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)906-2876		(833)906-2876		(866)281-2878		(866)281-2878		(833)906-2876		(833)906-2876		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2853	002	0	1	01	01	H2853_002_0	5	1						08/01/2022	2023.01	08/01/2022 12:40:12 PM Central Daylight Time	08/03/2022 08:37:12 PM Eastern Daylight Time	07/30/2022 09:00:59 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Saint Thomas Secure (HMO)	01	01		1			H2853	002	0	2023	Select counties in central Tennessee		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)906-2876		(833)906-2876		(866)281-2878		(866)281-2878		(833)906-2876		(833)906-2876		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2853	801	0	1	01	01	H2853_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:14:29 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H2853	801	0	2023	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	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:14:33 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H2853	802	0	2023	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	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:14:37 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H2853	803	0	2023	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	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:27:19 PM Pacific Daylight Time	08/04/2022 05:58:56 PM Pacific Daylight Time	08/01/2022 10:31:30 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	Select Counties in Wisconsin		2		2			1	3		1					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	7	1					1	08/04/2022	2023.01	08/04/2022 02:00:27 PM Pacific Daylight Time	08/04/2022 05:59:24 PM Pacific Daylight Time	08/01/2022 10:32:02 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WISCONSIN, INC.	Molina Healthcare of Wisconsin and Massachusetts	www.molinahealthcare.com/medicare	Senior Whole Health Medicare Choice Care (HMO)	01	01		1			H2879	002	0	2023	Select counties in Massachusetts		2		2			2									www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(833)685-2108		(833)685-2108		(888)566-3526		(888)566-3526		(833)685-2108		(833)685-2108		(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	7	1					1	08/04/2022	2023.01	08/04/2022 05:30:15 PM Pacific Daylight Time	08/04/2022 05:59:50 PM Pacific Daylight Time	08/01/2022 10:32:34 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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			
H2879	004	0	1	01	01	H2879_004_0	7	1					1	08/04/2022	2023.01	08/04/2022 02:02:10 PM Pacific Daylight Time	08/04/2022 06:00:18 PM Pacific Daylight Time	08/01/2022 03:26:44 PM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WISCONSIN, INC.	Molina Healthcare of Wisconsin and Massachusetts	www.molinahealthcare.com/medicare	Senior Whole Health Medicare Choice Care Select (HMO)	01	01		1			H2879	004	0	2023	Select counties in Massachusetts		2		2			2									www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(833)685-2108		(833)685-2108		(888)566-3526		(888)566-3526		(833)685-2108		(833)685-2108		(888)566-3526		(888)566-3526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2879	005	0	1	01	01	H2879_005_0	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:30:24 PM Pacific Daylight Time	08/04/2022 06:00:48 PM Pacific Daylight Time	08/01/2022 10:33:34 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WISCONSIN, INC.	Molina Healthcare of Wisconsin and Massachusetts	www.molinahealthcare.com/medicare	Molina Medicare Complete Care Select (HMO D-SNP)	01	01		1			H2879	005	0	2023	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			
H2882	003	0	1	20	08	H2882_003_0	1	1						06/02/2022	2023.01	06/02/2022 10:17:34 AM Eastern Daylight Time		06/02/2022 10:06:02 AM Eastern Daylight Time			06/02/2022 10:20:34 AM Eastern Daylight Time	PACE CENTRAL MICHIGAN, INC.	PACE Central Michigan	www.pacecmi.org	PACE Central Michigan (PACE)	08	20		1			H2882	003	0	2023	Central Michigan		2		2			2									https://www.tabularasahealthcare.com/	N/A												(989)953-5800				(989)953-5800												(771)-				(771)-																
H2882	004	0	1	20	08	H2882_004_0	1	1						06/02/2022	2023.01	06/02/2022 10:18:12 AM Eastern Daylight Time		06/02/2022 10:07:04 AM Eastern Daylight Time			06/02/2022 10:20:34 AM Eastern Daylight Time	PACE CENTRAL MICHIGAN, INC.	PACE Central Michigan	www.pacecmi.org	PACE Central Michigan (PACE)	08	20		1			H2882	004	0	2023	Central Michigan		2		2			2									https://www.tabularasahealthcare.com/	N/A												(989)953-5800				(989)953-5800												(771)-				(771)-																
H2915	002	0	1	01	01	H2915_002_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 02:37:17 PM Eastern Daylight Time	08/03/2022 07:54:10 PM Eastern Daylight Time	07/30/2022 09:01:35 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	Select counties in PA		2		2			1	3		1					1	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(866)330-9368		(866)330-9368		(844)917-0175		(844)917-0175		(866)330-9368		(866)330-9368		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	003	0	1	01	01	H2915_003_0	4	1						08/03/2022	2023.01	08/03/2022 04:03:56 PM Eastern Daylight Time	08/03/2022 07:55:20 PM Eastern Daylight Time	07/30/2022 09:02:07 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	Select counties in PA		2		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	2			
H2915	007	0	1	01	01	H2915_007_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 02:43:28 PM Eastern Daylight Time	08/03/2022 07:56:44 PM Eastern Daylight Time	07/30/2022 09:02:40 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	Select counties in PA		2		2			1	3		1					1	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(866)330-9368		(866)330-9368		(844)917-0175		(844)917-0175		(866)330-9368		(866)330-9368		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	011	0	1	01	01	H2915_011_0	4	1						05/26/2022	2023.01	05/26/2022 08:49:31 AM Eastern Daylight Time	08/03/2022 07:58:13 PM Eastern Daylight Time	07/30/2022 09:03:12 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	www.wellcare.com/allwellPA	Wellcare Assist (HMO)	01	01		1			H2915	011	0	2023	Select counties in PA		2		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	2			
H2915	012	0	1	01	01	H2915_012_0	4	1						08/01/2022	2023.01	08/01/2022 04:24:31 PM Eastern Daylight Time	08/03/2022 07:59:39 PM Eastern Daylight Time	07/30/2022 09:03:43 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	www.wellcare.com/allwellPA	Wellcare Giveback (HMO)	01	01		1			H2915	012	0	2023	Select counties in PA		2		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	2			
H2915	013	0	1	01	01	H2915_013_0	3	1				0	0	05/27/2022	2023.01	05/27/2022 08:26:42 PM Eastern Daylight Time	06/03/2022 07:10:46 PM Eastern Daylight Time				07/15/2022 04:25:45 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	2023	Select counties in PA		2		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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2915	016	0	1	01	01	H2915_016_0	5	1						08/03/2022	2023.01	08/03/2022 04:04:45 PM Eastern Daylight Time	08/03/2022 08:01:02 PM Eastern Daylight Time	07/30/2022 09:04:15 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	Select Counties in PA		2		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	2			
H2915	801	0	1	01	01	H2915_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:14:43 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	01	01		1			H2915	801	0	2023	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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:14:48 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	01	01		1			H2915	802	0	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:14:52 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	01	01		1			H2915	803	0	2023	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				
H2923	001	0	1	01	01	H2923_001_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:05:39 PM US Eastern Daylight Time	08/04/2022 09:43:34 AM Eastern Daylight Time	07/31/2022 01:46:41 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OREGON INC	Devoted Health	www.Devoted.com	Devoted CORE Oregon (HMO)	01	01		1			H2923	001	0	2023	Clackamas, Columbia, Multnomah, Washington		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			
H2926	001	0	1	01	01	H2926_001_0	16	1	2	1			0	07/11/2022	2023.01	07/11/2022 10:32:40 AM Central Daylight Time	08/01/2022 11:11:34 AM Central Daylight Time	08/01/2022 11:31:07 AM Central Daylight Time			08/01/2022 12:33:11 PM 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	2023	Northern, west central, and southwestern Minnesota		2		2			1	3		1					1	https://primewest.org/pharmacy-search	https://primewest.org/drug-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						05/23/2022	2023.01	05/23/2022 01:52:31 PM Eastern Daylight Time		05/23/2022 01:25:30 PM Eastern Daylight Time			05/23/2022 01:54:16 PM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	www.lifecircles-pace.org	LifeCircles (PACE)	08	20		1			H2936	001	0	2023	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						05/23/2022	2023.01	05/23/2022 01:46:41 PM Eastern Daylight Time		05/23/2022 01:25:36 PM Eastern Daylight Time			05/23/2022 01:54:16 PM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	www.lifecircles-pace.org	002 - Medicare Only (PACE)	08	20		1			H2936	002	0	2023	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						05/26/2022	2023.01	05/26/2022 10:31:56 AM Eastern Daylight Time		05/27/2022 10:18:00 AM Eastern Daylight Time			05/27/2022 10:22:23 AM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Senior LIFE Greensburg	www.seniorlifepa.com	Senior LIFE Greensburg Dual Eligible (PACE)	08	20		1			H2937	001	0	2023	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	1	1						05/26/2022	2023.01	05/26/2022 10:32:02 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Senior LIFE Greensburg	www.Seniorlifegreensburg.com	Senior LIFE Greensburg Medicare Only (PACE)	08	20		1			H2937	002	0	2023	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						06/06/2022	2023.01	06/06/2022 10:20:11 AM Eastern Daylight Time		06/06/2022 09:30:25 AM Eastern Daylight Time			06/06/2022 10:21:52 AM 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	2023	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						06/06/2022	2023.01	06/06/2022 10:20:35 AM Eastern Daylight Time		06/06/2022 09:30:27 AM Eastern Daylight Time			06/06/2022 10:21:52 AM 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	2023	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																
H2942	001	0	1	01	01	H2942_001_0	9	1						08/04/2022	2023.01	08/04/2022 08:38:23 AM Central Daylight Time	08/03/2022 04:37:46 PM Central Daylight Time	08/03/2022 04:37:46 PM Central Daylight Time			08/04/2022 08:42:23 AM Central Daylight Time	COX HEALTH SYSTEMS HMO INC	Cox HealthPlans	www.coxhealthmedicareadvantage.com	CoxHealth Medicare Advantage (HMO)	01	01		1			H2942	001	0	2023	Counties: GRE CHR WEB STO TAN BAR LAW		2		2			2									www.coxhealthmedicareadvantage.com	www.coxhealthmedicareadvantage.com	www.coxhealthplans.com	(855)752-3796		(417)269-2909		(855)752-3795		(417)269-2907		(855)476-5985		(417)269-2909		(855)752-3795		(417)269-2907		(800)735-2966		(711)-		(800)735-2966		(711)-		(800)735-2966		(711)-		(800)735-2966		(711)-		2					2					2	2			
H2944	013	0	1	09	04	H2944_013_0	4	1						06/02/2022	2023.01	06/02/2022 09:54:06 AM Eastern Daylight Time	08/03/2022 03:40:45 PM Eastern Daylight Time	07/30/2022 06:30:44 AM Eastern Daylight Time			08/04/2022 11:40:13 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-013 (PFFS)	04	09	3	1			H2944	013	0	2023	Select Counties in KS, MO and OK		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	05/30/2022	2023.01	05/30/2022 04:06:26 PM Eastern Daylight Time	07/18/2022 04:56:16 PM Eastern Daylight Time				07/20/2022 01:59:46 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	2023	Select Counties in KS, MO and OK		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1				0	0	07/11/2022	2023.01	07/11/2022 01:37:54 PM Pacific Daylight Time	06/06/2022 05:26:35 PM Pacific Daylight Time				07/11/2022 01:47:31 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	2023	Washoe, Carson City Counties, NV		2		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	3	1					1	08/05/2022	2023.01	08/05/2022 08:41:36 AM Pacific Daylight Time	08/05/2022 12:39:30 PM Pacific Daylight Time	08/05/2022 12:39:50 PM Pacific Daylight Time			08/05/2022 12:40:44 PM 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	2023	Washoe, Carson City Counties, NV		2		2			2									www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;7a;9a1;9a2;9b;	
H2960	018	0	1	01	01	H2960_018_0	4	1					1	08/05/2022	2023.01	08/05/2022 08:43:53 AM Pacific Daylight Time	08/05/2022 12:39:30 PM Pacific Daylight Time	08/05/2022 12:39:50 PM Pacific Daylight Time			08/05/2022 12:44:57 PM 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	2023	Washoe, Carson City Counties, NV		2		2			2									www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;7a;9a1;9a2;9b;	
H2960	019	0	1	01	01	H2960_019_0	5	1					1	08/05/2022	2023.01	08/05/2022 08:45:36 AM Pacific Daylight Time	08/05/2022 12:39:30 PM Pacific Daylight Time	08/05/2022 12:39:50 PM Pacific Daylight Time			08/05/2022 12:46:42 PM 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	2023	Clark and Nye Counties		2		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	023	0	1	01	01	H2960_023_0	4	1					1	08/05/2022	2023.01	08/05/2022 08:51:17 AM Pacific Daylight Time	08/05/2022 12:39:30 PM Pacific Daylight Time	08/05/2022 12:39:50 PM Pacific Daylight Time			08/05/2022 12:48:02 PM 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	2023	Washoe, Carson City Counties, NV		2		2			2									www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;9a1;9a2;9b;	
H2960	024	0	1	01	01	H2960_024_0	6	1	2	1			0	08/05/2022	2023.01	08/05/2022 08:48:06 AM Pacific Daylight Time	08/05/2022 12:39:30 PM Pacific Daylight Time	08/05/2022 12:39:50 PM Pacific Daylight Time			08/05/2022 12:49:27 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	2023	Washoe, Carson City Counties, NV		2		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	1	1						06/06/2022	2023.01	06/06/2022 04:20:26 PM Pacific Daylight Time					06/06/2022 04:56:42 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	2023	State of Nevada		1	3500	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	08/02/2022	2023.01	08/02/2022 06:51:36 PM Eastern Daylight Time	08/03/2022 09:59:41 AM Eastern Daylight Time	08/03/2022 09:57:57 AM Eastern Daylight Time			08/03/2022 10:43:29 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	001	0	2023	Hernando County		2		2			2									www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:57:11 AM Eastern Daylight Time	08/03/2022 10:00:35 AM Eastern Daylight Time	08/03/2022 10:21:49 AM Eastern Daylight Time			08/03/2022 10:43:29 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	013	3	2023	Citrus and Pasco Counties, FL	Pasco County	2		2			2									www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:47:06 AM Eastern Daylight Time	08/03/2022 10:01:02 AM Eastern Daylight Time	08/03/2022 10:22:12 AM Eastern Daylight Time			08/03/2022 10:43:29 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	013	4	2023	Citrus and Pasco Counties, FL	Citrus County	2		2			2									www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:47:52 AM Eastern Daylight Time	08/03/2022 10:01:28 AM Eastern Daylight Time	08/03/2022 10:22:35 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Hernando and Pasco Counties in Florida	Hernando County, FL	2		2			1	4			00000000000000001000000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:48:44 AM Eastern Daylight Time	08/03/2022 10:01:55 AM Eastern Daylight Time	08/03/2022 10:22:59 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Hernando and Pasco Counties in Florida	Pasco County, FL	2		2			1	4			00000000000000001000000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	021	0	1	01	01	H2962_021_0	8	1		1	2		1	07/21/2022	2023.01	07/21/2022 03:35:36 PM Eastern Daylight Time	08/03/2022 10:02:22 AM Eastern Daylight Time	08/03/2022 09:59:06 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Citrus County, FL		2		2			1	4			00000000000000001000000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:50:05 AM Eastern Daylight Time	08/03/2022 10:02:50 AM Eastern Daylight Time	08/03/2022 09:59:28 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Citrus County, FL		2		2			1	4			00001000000000000000000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:50:44 AM Eastern Daylight Time	08/03/2022 10:03:17 AM Eastern Daylight Time	08/03/2022 09:59:51 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Citrus, Lake, Marion and Sumter Counties, FL		2		2			1	4			00000000000100000000000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:51:26 AM Eastern Daylight Time	08/03/2022 10:03:44 AM Eastern Daylight Time	08/03/2022 10:00:13 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Hernando and Pasco Counties, FL		2		2			1	4			00001000000000000000000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	025	0	1	01	01	H2962_025_0	8	1		1	2		1	07/21/2022	2023.01	07/21/2022 03:35:57 PM Eastern Daylight Time	08/03/2022 10:04:10 AM Eastern Daylight Time	08/03/2022 10:00:36 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Her, Hil, Pas and Pin Counties, FL		2		2			1	4			00000000000100000000000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	026	0	1	01	01	H2962_026_0	8	1		1	2		1	07/21/2022	2023.01	07/21/2022 03:36:20 PM Eastern Daylight Time	08/03/2022 10:04:37 AM Eastern Daylight Time	08/03/2022 10:00:59 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Counties: HIL, MTE, ORA, OSC, PIN, POL, SAR, SEM		2		2			1	4			00000000000000000010000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	028	0	1	01	01	H2962_028_0	8	1			2		1	07/21/2022	2023.01	07/21/2022 03:36:40 PM Eastern Daylight Time	08/03/2022 10:05:02 AM Eastern Daylight Time	08/03/2022 10:01:21 AM Eastern Daylight Time			08/03/2022 10:43:29 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	028	0	2023	Marion, Lake and Sumter Counties, FL		2		2			2									www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	029	0	1	01	01	H2962_029_0	8	1		1	2		1	07/21/2022	2023.01	07/21/2022 03:37:29 PM Eastern Daylight Time	08/03/2022 10:06:14 AM Eastern Daylight Time	08/03/2022 10:01:44 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Marion, Lake and Sumter Counties, FL		2		2			1	4			00000000000000000010000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:55:35 AM Eastern Daylight Time	08/03/2022 10:06:39 AM Eastern Daylight Time	08/03/2022 10:02:06 AM Eastern Daylight Time			08/03/2022 10:43:29 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	031	0	2023	Indian River and St. Lucie Counties, FL		2		2			2									www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:56:23 AM Eastern Daylight Time	08/03/2022 10:07:07 AM Eastern Daylight Time	08/03/2022 10:02:29 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Cit, Her, Ind, Pas and SLu Counties, FL		2		2			2									www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:58:02 AM Eastern Daylight Time	08/03/2022 10:08:07 AM Eastern Daylight Time	08/03/2022 10:02:51 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Indian River and St. Lucie Counties, FL		2		2			1	4			00000000000000000010000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/20/2022	2023.01	07/20/2022 10:58:34 AM Eastern Daylight Time	08/03/2022 10:08:33 AM Eastern Daylight Time	08/03/2022 10:03:13 AM Eastern Daylight Time			08/03/2022 10:43:29 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	2023	Ind,Man,Ora,Osc,Pol,Sar,Sem and SLu Counties, FL		2		2			1	4			00000000000100000000000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	035	0	1	01	01	H2962_035_0	7	1	2	1	1		0	07/20/2022	2023.01	07/20/2022 10:58:50 AM Eastern Daylight Time	08/03/2022 10:09:02 AM Eastern Daylight Time	08/03/2022 10:03:36 AM Eastern Daylight Time			08/03/2022 10:43:29 AM 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	2023	All Service Area		2		2			1	3		2					2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	036	0	1	01	01	H2962_036_0	7	1	2	1	1		0	07/20/2022	2023.01	07/20/2022 10:59:03 AM Eastern Daylight Time	08/03/2022 10:09:56 AM Eastern Daylight Time	08/03/2022 10:03:58 AM Eastern Daylight Time			08/03/2022 10:43:29 AM 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	2023	All Service Area		2		2			1	3		2					2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(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	07/21/2022	2023.01	07/21/2022 03:29:25 PM Eastern Daylight Time	08/03/2022 10:10:22 AM Eastern Daylight Time	08/03/2022 10:04:21 AM Eastern Daylight Time			08/03/2022 10:43:29 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	045	0	2023	Hillsborough, Pinellas and Polk Counties		2		2			2									www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	046	0	1	01	01	H2962_046_0	9	1			2		1	07/21/2022	2023.01	07/21/2022 03:38:04 PM Eastern Daylight Time	08/03/2022 10:10:48 AM Eastern Daylight Time	08/03/2022 10:04:43 AM Eastern Daylight Time			08/03/2022 10:43:29 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	046	0	2023	Orange, Osceola and Seminole Counties		2		2			2									www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	047	0	1	01	01	H2962_047_0	9	1			2		1	07/21/2022	2023.01	07/21/2022 03:39:06 PM Eastern Daylight Time	08/03/2022 10:11:14 AM Eastern Daylight Time	08/03/2022 10:05:06 AM Eastern Daylight Time			08/03/2022 10:43:29 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	047	0	2023	Manatee and Sarasota Counties		2		2			2									www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	050	0	1	01	01	H2962_050_0	10	1		1	2		1	07/21/2022	2023.01	07/21/2022 03:38:58 PM Eastern Daylight Time	08/03/2022 10:11:43 AM Eastern Daylight Time	08/03/2022 10:05:28 AM Eastern Daylight Time			08/03/2022 10:43:29 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	050	0	2023	Orange, Osceola and Seminole Counties		2		2			1	4			00000000000000000010000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	051	0	1	01	01	H2962_051_0	10	1		1	2		1	07/21/2022	2023.01	07/21/2022 03:39:27 PM Eastern Daylight Time	08/03/2022 10:12:35 AM Eastern Daylight Time	08/03/2022 10:05:51 AM Eastern Daylight Time			08/03/2022 10:43:29 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	051	0	2023	Polk County		2		2			1	4			00000000000000000010000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	052	0	1	01	01	H2962_052_0	10	1		1	2		1	07/21/2022	2023.01	07/21/2022 03:39:46 PM Eastern Daylight Time	08/03/2022 10:13:02 AM Eastern Daylight Time	08/03/2022 10:06:14 AM Eastern Daylight Time			08/03/2022 10:43:29 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	052	0	2023	Manatee and Sarasota Counties		2		2			1	4			00000000000000000010000					www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)306-4568		(855)858-7526		(352)691-5009		(800)311-7517		(706)776-1955		(855)858-7526		(352)691-5009		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	001	0	1	01	01	H2986_001_0	10	1					1	06/06/2022	2023.01	06/06/2022 08:46:30 AM Central Daylight Time	08/02/2022 11:28:26 AM Central Daylight Time	08/02/2022 11:25:44 AM Central Daylight Time			08/04/2022 09:39:24 AM Central Daylight Time	Essence Healthcare of California, Inc.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Platinum (HMO)	01	01		1			H2986	001	0	2023	Santa Clara County		2		2			2									www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(855)996-8422		(855)996-8422		(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	13	1					1	06/03/2022	2023.01	06/03/2022 03:54:34 PM Central Daylight Time	08/02/2022 01:05:56 PM Central Daylight Time	08/02/2022 12:03:49 PM Central Daylight Time			08/04/2022 09:39:24 AM Central Daylight Time	Essence Healthcare of California, Inc.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Gold (HMO)	01	01		1			H2986	002	0	2023	Santa Clara County		2		2			2									www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(855)996-8422		(855)996-8422		(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	11	1					1	06/03/2022	2023.01	06/03/2022 03:54:49 PM Central Daylight Time	08/02/2022 01:26:15 PM Central Daylight Time	08/02/2022 01:21:05 PM Central Daylight Time			08/04/2022 09:39:24 AM Central Daylight Time	Essence Healthcare of California, Inc.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Platinum (HMO)	01	01		1			H2986	004	0	2023	Alameda and San Mateo Counties		2		2			2									www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(855)996-8422		(855)996-8422		(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	12	1					1	06/03/2022	2023.01	06/03/2022 03:55:08 PM Central Daylight Time	08/02/2022 02:20:33 PM Central Daylight Time	08/02/2022 02:13:32 PM Central Daylight Time			08/04/2022 09:39:24 AM Central Daylight Time	Essence Healthcare of California, Inc.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Gold (HMO)	01	01		1			H2986	007	0	2023	Alameda and San Mateo Counties		2		2			2									www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	008	0	1	01	01	H2986_008_0	13	1					1	08/02/2022	2023.01	08/02/2022 07:13:28 AM Central Daylight Time	08/02/2022 02:47:33 PM Central Daylight Time	08/02/2022 02:51:03 PM Central Daylight Time			08/04/2022 09:39:24 AM Central Daylight Time	Essence Healthcare of California, Inc.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Select (HMO)	01	01		1			H2986	008	0	2023	Santa Clara County		2		2			2									www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(855)996-8422		(855)996-8422		(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						06/01/2022	2023.01	06/01/2022 02:38:01 PM Central Daylight Time					06/03/2022 12:50:32 PM Central Daylight Time	Essence Healthcare of California, Inc.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD Calendar Year (HMO)	01	01		1			H2986	801	0	2023	Alameda, Santa Clara, San Mateo counties		1	300	2			2									www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(855)996-8422		(855)996-8422		(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						06/01/2022	2023.01	06/01/2022 02:39:14 PM Central Daylight Time					06/03/2022 12:50:32 PM Central Daylight Time	Essence Healthcare of California, Inc.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD non-Calendar Year (HMO)	01	01		1			H2986	802	0	2023	Alameda, Santa Clara, San Mateo counties		1	300	2			2									www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(855)996-8422		(855)996-8422		(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	06/01/2022	2023.01	06/01/2022 02:40:22 PM Central Daylight Time					06/03/2022 12:50:32 PM Central Daylight Time	Essence Healthcare of California, Inc.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only Calendar Year (HMO)	01	01		1			H2986	803	0	2023	Alameda, Santa Clara, San Mateo counties		1	300	2			2									www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(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	06/01/2022	2023.01	06/01/2022 02:41:34 PM Central Daylight Time					06/03/2022 12:50:32 PM Central Daylight Time	Essence Healthcare of California, Inc.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only non-Calendar Year (HMO)	01	01		1			H2986	804	0	2023	Alameda, Santa Clara, San Mateo counties		1	300	2			2									www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(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	1	1						05/26/2022	2023.01	05/26/2022 10:32:12 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM 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	2023	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	1	1						05/26/2022	2023.01	05/26/2022 10:32:25 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM 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	2023	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	1	1						05/26/2022	2023.01	05/26/2022 10:32:32 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM 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	2023	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	1	1						05/26/2022	2023.01	05/26/2022 10:32:39 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM 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	2023	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	5	1	2	1	1		0	08/05/2022	2023.01	08/05/2022 12:06:32 PM Eastern Daylight Time	08/03/2022 04:08:38 PM Eastern Daylight Time	08/01/2022 03:51:36 PM Eastern Daylight Time			08/05/2022 12:55:13 PM 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	2023	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			
H3041	001	0	1	01	01	H3041_001_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:06:10 PM US Eastern Daylight Time	08/04/2022 09:43:58 AM Eastern Daylight Time	07/31/2022 01:47:03 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Devoted Health	www.Devoted.com	Devoted CORE Upstate (HMO)	01	01		1			H3041	001	0	2023	Upstate South Carolina		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			
H3047	001	0	1	04	01	H3047_001_0	4	1						08/01/2022	2023.01	08/01/2022 04:15:09 PM Eastern Daylight Time	08/03/2022 08:19:19 PM Eastern Daylight Time	07/30/2022 09:04:46 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in LA		2		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						08/03/2022	2023.01	08/03/2022 02:25:11 PM Eastern Daylight Time	08/03/2022 08:20:19 PM Eastern Daylight Time	07/30/2022 09:05:19 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in LA		2		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	5	1						06/02/2022	2023.01	06/02/2022 09:07:08 AM Pacific Daylight Time	08/03/2022 08:21:19 PM Eastern Daylight Time	07/30/2022 09:05:51 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in LA		2		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						06/02/2022	2023.01	06/02/2022 04:51:20 PM Eastern Daylight Time		06/03/2022 09:06:49 AM Eastern Daylight Time			06/03/2022 09:17:03 AM Eastern Daylight Time	VIECARE BUTLER, LLC	LIFE Butler County	www.lutheranseniorlife.org	VieCare Butler, LLC dba LIFE Butler County (PACE)	08	20		1			H3060	001	0	2023	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						06/02/2022	2023.01	06/02/2022 04:51:36 PM Eastern Daylight Time		06/03/2022 09:06:52 AM Eastern Daylight Time			06/03/2022 09:17:03 AM Eastern Daylight Time	VIECARE BUTLER, LLC	LIFE Butler County	www.lutheranseniorlife.org	VieCare Butler, LLC dba LIFE Butler County (PACE)	08	20		1			H3060	002	0	2023	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	5	1					1	08/03/2022	2023.01	08/03/2022 07:53:21 AM Central Daylight Time	08/04/2022 03:27:56 PM Central Daylight Time	08/04/2022 03:36:50 PM Central Daylight Time			08/04/2022 04:25:51 PM Central Daylight Time	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Community Advantage Plan (HMO)	01	01		1			H3071	002	0	2023	Rockford Area, Chicago Area		2		2			2									www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	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			
H3080	001	0	1	01	01	H3080_001_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 09:24:24 AM US Eastern Daylight Time	08/04/2022 09:44:21 AM Eastern Daylight Time	07/31/2022 01:47:24 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ALABAMA INC	Devoted Health	www.Devoted.com	Devoted CORE Alabama (HMO)	01	01		1			H3080	001	0	2023	Birmingham, Mobile, Montgomery		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			
H3080	002	0	1	01	01	H3080_002_0	11	1			2		0	08/03/2022	2023.01	08/03/2022 09:26:27 AM US Eastern Daylight Time	08/04/2022 09:44:44 AM Eastern Daylight Time	07/31/2022 01:47:46 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ALABAMA INC	Devoted Health	www.Devoted.com	Devoted GIVEBACK Alabama (HMO)	01	01		1			H3080	002	0	2023	Birmingham, Mobile, Montgomery		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			
H3080	003	0	1	01	01	H3080_003_0	9	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:27:49 AM US Eastern Daylight Time	08/04/2022 09:45:11 AM Eastern Daylight Time	07/31/2022 01:48:07 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ALABAMA INC	Devoted Health	www.Devoted.com	Devoted DUAL Alabama - 1 (HMO D-SNP)	01	01		1			H3080	003	0	2023	Birmingham, Mobile, Montgomery		2		2			1	3		1					1	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			
H3080	004	0	1	01	01	H3080_004_0	9	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:28:51 AM US Eastern Daylight Time	08/04/2022 09:45:36 AM Eastern Daylight Time	07/31/2022 01:48:29 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ALABAMA INC	Devoted Health	www.Devoted.com	Devoted DUAL Alabama - 2 (HMO D-SNP)	01	01		1			H3080	004	0	2023	Birmingham, Mobile, Montgomery		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			
H3080	005	0	1	01	01	H3080_005_0	9	1			2		1	08/03/2022	2023.01	08/03/2022 09:29:42 AM US Eastern Daylight Time	08/04/2022 09:46:01 AM Eastern Daylight Time	07/31/2022 01:48:50 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ALABAMA INC	Devoted Health	www.Devoted.com	Devoted CORE Alabama (HMO)	01	01		1			H3080	005	0	2023	Colbert and Lauderdale 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			
H3080	006	0	1	01	01	H3080_006_0	9	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 03:07:23 PM US Eastern Daylight Time	08/04/2022 09:46:26 AM Eastern Daylight Time	07/31/2022 01:49:12 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ALABAMA INC	Devoted Health	www.Devoted.com	Devoted DUAL Alabama - 1 (HMO D-SNP)	01	01		1			H3080	006	0	2023	Colbert and Lauderdale Counties		2		2			1	3		1					1	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			
H3080	007	0	1	01	01	H3080_007_0	9	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 03:08:21 PM US Eastern Daylight Time	08/04/2022 09:46:50 AM Eastern Daylight Time	07/31/2022 01:49:34 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ALABAMA INC	Devoted Health	www.Devoted.com	Devoted DUAL Alabama - 2 (HMO D-SNP)	01	01		1			H3080	007	0	2023	Colbert and Lauderdale 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			
H3084	001	0	1	20	08	H3084_001_0	1	1						06/02/2022	2023.01	06/02/2022 08:23:58 AM Pacific Daylight Time		06/02/2022 08:20:00 AM Pacific Daylight Time			06/02/2022 08:25:34 AM 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	2023	Parts of King County		2		2			2									NA	NA										(888)660-7223		(206)462-7100		(888)660-7223		(206)462-7100												(206)489-0629				(206)489-0629																
H3084	002	0	1	20	08	H3084_002_0	1	1						06/02/2022	2023.01	06/02/2022 08:24:19 AM Pacific Daylight Time		06/02/2022 08:20:00 AM Pacific Daylight Time			06/02/2022 08:25:34 AM 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	2023	Parts of King County		2		2			2									NA	NA										(888)660-7223		(206)462-7100		(888)660-7223		(206)462-7100												(206)489-0629				(206)489-0629																
H3113	001	0	1	01	01	H3113_001_0	4	1		1	2		0	08/15/2022	2023.01	08/15/2022 11:09:18 AM Central Daylight Time	08/03/2022 10:45:36 AM Central Daylight Time	07/31/2022 02:05:09 AM Central Daylight Time			08/15/2022 04:25:38 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	2023	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	07/15/2022	2023.01	07/15/2022 02:25:15 PM Central Daylight Time	08/03/2022 10:46:17 AM Central Daylight Time	07/31/2022 02:05:34 AM Central Daylight Time			08/04/2022 04:46:28 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	2023	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	3	1		1	2		1	08/15/2022	2023.01	08/15/2022 11:09:26 AM Central Daylight Time	08/03/2022 10:46:59 AM Central Daylight Time	07/31/2022 02:05:58 AM Central Daylight Time			08/15/2022 04:25:38 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	2023	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	02	01	H3113_009_0	2	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 01:04:43 PM Central Daylight Time	08/03/2022 10:47:41 AM Central Daylight Time	07/31/2022 02:06:23 AM Central Daylight Time			08/04/2022 04:46:28 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHC.com/PADual	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H3113	009	0	2023	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	02	01	H3113_010_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 11:35:43 AM Central Daylight Time	08/03/2022 10:48:21 AM Central Daylight Time	07/31/2022 02:06:48 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H3113	010	0	2023	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	02	01	H3113_011_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 02:19:49 PM Central Daylight Time	08/03/2022 10:49:00 AM Central Daylight Time	07/31/2022 02:07:12 AM Central Daylight Time			08/04/2022 04:46:28 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H3113	011	0	2023	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	02	01	H3113_013_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 03:31:00 PM Central Daylight Time	08/03/2022 10:49:43 AM Central Daylight Time	07/31/2022 02:07:37 AM Central Daylight Time			08/04/2022 04:46:28 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H3113	013	0	2023	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	02	01	H3113_014_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 03:31:20 PM Central Daylight Time	08/03/2022 10:50:25 AM Central Daylight Time	07/31/2022 02:08:02 AM Central Daylight Time			08/04/2022 04:46:28 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHC.com/PADual	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H3113	014	0	2023	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	5	1		1			1	08/09/2022	2023.01	08/09/2022 12:43:28 PM Pacific Daylight Time	08/09/2022 12:42:28 PM Pacific Daylight Time	08/09/2022 12:42:45 PM Pacific Daylight Time			08/09/2022 12:46:36 PM Pacific Daylight Time	AHF MCO OF FLORIDA, INC.	AHF	www.php-fl.org	PHP (HMO C-SNP)	01	01		1			H3132	001	0	2023	Broward, Miami-Dade and Duval Counties, Florida		2		2			1	4			00000000001000000000000					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	2	1			2		0	08/02/2022	2023.01	08/02/2022 04:11:34 PM Eastern Daylight Time	08/02/2022 08:04:59 PM Eastern Daylight Time	07/31/2022 09:44:16 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	2	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 07:08:17 PM Eastern Daylight Time	08/02/2022 08:06:00 PM Eastern Daylight Time	07/31/2022 09:44:42 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 01:45:55 PM Eastern Daylight Time	08/02/2022 08:07:01 PM Eastern Daylight Time	07/31/2022 09:45:16 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:09:49 PM Eastern Daylight Time	08/02/2022 08:08:01 PM Eastern Daylight Time	07/31/2022 09:45:42 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	006	0	1	01	01	H3146_006_0	2	1			1		0	05/31/2022	2023.01	05/31/2022 04:55:00 PM Eastern Daylight Time	08/02/2022 08:09:05 PM Eastern Daylight Time	07/31/2022 09:46:08 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	08/02/2022	2023.01	08/02/2022 12:13:18 PM Eastern Daylight Time	08/02/2022 08:10:06 PM Eastern Daylight Time	07/31/2022 09:46:34 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 01:49:11 PM Eastern Daylight Time	08/02/2022 08:11:07 PM Eastern Daylight Time	07/31/2022 09:47:00 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 01:51:44 PM Eastern Daylight Time	08/02/2022 08:12:08 PM Eastern Daylight Time	07/31/2022 09:47:26 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	011	0	1	01	01	H3146_011_0	2	1			1		0	05/31/2022	2023.01	05/31/2022 04:55:46 PM Eastern Daylight Time	08/02/2022 08:13:12 PM Eastern Daylight Time	07/31/2022 09:47:52 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	2	1			1		0	05/31/2022	2023.01	05/31/2022 04:56:00 PM Eastern Daylight Time	08/02/2022 08:14:14 PM Eastern Daylight Time	07/31/2022 09:48:16 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	2	1			1		0	05/31/2022	2023.01	05/31/2022 04:56:13 PM Eastern Daylight Time	08/02/2022 08:15:14 PM Eastern Daylight Time	07/31/2022 09:48:42 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:16:20 PM Eastern Daylight Time	08/02/2022 08:16:14 PM Eastern Daylight Time	07/31/2022 09:49:08 PM Eastern Daylight Time			08/04/2022 05:33:38 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	2023	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	015	0	1	01	01	H3146_015_0	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 01:57:33 PM Eastern Daylight Time	08/02/2022 08:17:13 PM Eastern Daylight Time	07/31/2022 09:49:34 PM Eastern Daylight Time			08/04/2022 05:33:38 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	015	0	2023	Sandhills		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	016	0	1	01	01	H3146_016_0	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 01:58:58 PM Eastern Daylight Time	08/02/2022 08:18:12 PM Eastern Daylight Time	07/31/2022 09:49:58 PM Eastern Daylight Time			08/04/2022 05:33:38 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	016	0	2023	Upstate		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	017	0	1	01	01	H3146_017_0	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:00:35 PM Eastern Daylight Time	08/02/2022 08:19:13 PM Eastern Daylight Time	07/31/2022 09:50:24 PM Eastern Daylight Time			08/04/2022 05:33:38 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	017	0	2023	Midlands		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	801	0	1	01	01	H3146_801_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 10:17:24 AM Eastern Daylight Time					06/02/2022 03:02:32 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3146	801	0	2023	North Carolina		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3146	802	0	1	01	01	H3146_802_0	1	1						05/30/2022	2023.01	05/30/2022 10:18:43 AM Eastern Daylight Time					06/02/2022 03:02:32 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	2023	North Carolina		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3152	022	0	1	02	01	H3152_022_0	4	1						05/31/2022	2023.01	05/31/2022 05:46:05 PM Central Daylight Time	08/02/2022 03:57:19 PM Central Daylight Time	07/31/2022 08:50:50 PM Central Daylight Time			08/04/2022 03:52:26 PM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier (HMO-POS)	01	02		1			H3152	022	0	2023	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	2			
H3152	045	0	1	01	01	H3152_045_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 05:49:03 PM Central Daylight Time	06/01/2022 11:46:17 AM Central Daylight Time				06/02/2022 11:55:30 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO)	01	01		1			H3152	045	0	2023	New Jersey Counties: All		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	2			
H3152	048	0	1	02	01	H3152_048_0	2	1						05/31/2022	2023.01	05/31/2022 05:49:30 PM Central Daylight Time	08/02/2022 03:59:09 PM Central Daylight Time	07/31/2022 08:51:16 PM Central Daylight Time			08/04/2022 03:52:26 PM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plus (HMO-POS)	01	02		1			H3152	048	0	2023	Northern New Jersey		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			
H3152	080	0	1	02	01	H3152_080_0	2	1						08/02/2022	2023.01	08/02/2022 02:18:12 PM Central Daylight Time	08/02/2022 04:00:03 PM Central Daylight Time	07/31/2022 08:51:40 PM Central Daylight Time			08/04/2022 03:52:26 PM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Value (HMO-POS)	01	02		1			H3152	080	0	2023	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	2			
H3152	082	0	1	01	01	H3152_082_0	2	1						08/02/2022	2023.01	08/02/2022 06:12:38 PM Central Daylight Time	08/02/2022 04:00:58 PM Central Daylight Time	07/31/2022 08:52:06 PM Central Daylight Time			08/04/2022 03:52:26 PM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Value (HMO)	01	01		1			H3152	082	0	2023	Southern NJ, Middlesex and Monmouth 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	2			
H3152	084	0	1	01	01	H3152_084_0	2	1						08/02/2022	2023.01	08/02/2022 02:58:49 PM Central Daylight Time	08/02/2022 04:01:54 PM Central Daylight Time	07/31/2022 08:52:32 PM Central Daylight Time			08/04/2022 03:52:26 PM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Elite (HMO)	01	01		1			H3152	084	0	2023	Northern-New Jersey East		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			
H3152	088	0	1	01	01	H3152_088_0	2	1						08/02/2022	2023.01	08/02/2022 03:02:01 PM Central Daylight Time	08/02/2022 04:02:50 PM Central Daylight Time	07/31/2022 08:52:56 PM Central Daylight Time			08/04/2022 03:52:26 PM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite 3 (HMO)	01	01		1			H3152	088	0	2023	New Jersey Counties: All		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			
H3152	092	0	1	01	01	H3152_092_0	2	1						08/02/2022	2023.01	08/02/2022 03:04:03 PM Central Daylight Time	08/02/2022 04:03:45 PM Central Daylight Time	07/31/2022 08:53:22 PM Central Daylight Time			08/04/2022 03:52:26 PM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Elite 2 (HMO)	01	01		1			H3152	092	0	2023	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	(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			
H3152	801	0	1	01	01	H3152_801_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 10:12:59 AM Eastern Daylight Time					06/02/2022 03:04:24 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3152	801	0	2023	New Jersey		1	155030	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3152	804	0	1	01	01	H3152_804_0	1	1						05/30/2022	2023.01	05/30/2022 10:15:25 AM Eastern Daylight Time					06/02/2022 03:04:24 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	2023	New Jersey		1	6510	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3170	003	1	1	01	01	H3170_003_1	7	1						08/04/2022	2023.01	08/04/2022 10:38:47 AM Eastern Daylight Time	08/05/2022 08:29:13 AM Eastern Daylight Time	08/04/2022 01:25:05 PM Eastern Daylight Time			08/05/2022 09:14:21 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	2023	Omaha/Lincoln Metro Area and Central Nebraska	Metro Area	2		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	7	1						08/02/2022	2023.01	08/02/2022 04:37:37 PM Eastern Daylight Time	08/04/2022 01:24:30 PM Eastern Daylight Time	08/04/2022 01:25:12 PM Eastern Daylight Time			08/05/2022 09:14:21 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	2023	Omaha/Lincoln Metro Area and Central Nebraska	Central Nebraska	2		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	5	1					1	08/03/2022	2023.01	08/03/2022 02:34:34 PM Central Daylight Time	08/03/2022 11:36:57 AM Central Daylight Time	08/02/2022 11:07:14 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	SANFORD HEALTH PLAN OF MINNESOTA	Sanford Health Plan of Minnesota	www.align.sanfordhealthplan.com	Align ChoiceElite (PPO)	01	04		1			H3186	001	0	2023	Minnesota		2		2			2									www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	(888)278-6485		(888)278-6485		(888)605-9277		(605)328-7200		(844)642-9090		(844)642-9090		(888)605-9277		(605)328-7200		(888)279-1549		(888)279-1549		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3186	002	0	1	04	01	H3186_002_0	5	1					1	08/03/2022	2023.01	08/03/2022 02:34:53 PM Central Daylight Time	08/03/2022 11:37:31 AM Central Daylight Time	08/02/2022 11:09:03 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	SANFORD HEALTH PLAN OF MINNESOTA	Sanford Health Plan of Minnesota	www.align.sanfordhealthplan.com	Align ChoicePlus (PPO)	01	04		1			H3186	002	0	2023	Minnesota		2		2			2									www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	(888)278-6485		(888)278-6485		(888)605-9277		(605)328-7200		(844)642-9090		(844)642-9090		(888)605-9277		(605)328-7200		(888)279-1549		(888)279-1549		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3189	001	0	1	01	01	H3189_001_0	6	1					1	08/02/2022	2023.01	08/02/2022 04:15:15 PM Central Daylight Time	08/05/2022 05:22:38 AM Central Daylight Time	08/05/2022 05:22:10 AM Central Daylight Time			08/05/2022 05:38:11 AM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H3189	001	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3189	002	0	1	01	01	H3189_002_0	6	1					1	08/02/2022	2023.01	08/02/2022 02:23:54 PM Central Daylight Time	08/05/2022 05:22:47 AM Central Daylight Time	08/05/2022 05:22:20 AM Central Daylight Time			08/05/2022 05:38:11 AM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	01	01		1			H3189	002	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3189	801	0	1	01	01	H3189_801_0	2	1						05/26/2022	2023.01	05/26/2022 04:31:08 PM Central Daylight Time					06/03/2022 12:28:02 PM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD Calendar Year (HMO)	01	01		1			H3189	801	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H3189	802	0	1	01	01	H3189_802_0	2	1						05/26/2022	2023.01	05/26/2022 03:57:10 PM Central Daylight Time					06/03/2022 12:28:02 PM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD non-Calendar Year (HMO)	01	01		1			H3189	802	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H3189	803	0	1	01	01	H3189_803_0	2	1				0	0	05/26/2022	2023.01	05/26/2022 03:59:07 PM Central Daylight Time					06/03/2022 12:28:02 PM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only Calendar Year (HMO)	01	01		1			H3189	803	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H3189	804	0	1	01	01	H3189_804_0	2	1				0	0	05/26/2022	2023.01	05/26/2022 03:59:25 PM Central Daylight Time					06/03/2022 12:28:02 PM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only non-Calendar Year (HMO)	01	01		1			H3189	804	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H3192	001	0	1	02	01	H3192_001_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 10:24:49 AM Eastern Daylight Time	08/03/2022 02:46:50 PM Eastern Daylight Time	07/31/2022 09:53:50 PM Eastern Daylight Time			08/04/2022 04:26:00 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	2023	IL Chicago		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			
H3192	002	0	1	02	01	H3192_002_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 10:25:32 AM Eastern Daylight Time	08/03/2022 02:47:46 PM Eastern Daylight Time	07/31/2022 09:54:14 PM Eastern Daylight Time			08/04/2022 04:26:00 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	2023	MI Middle		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			
H3192	003	0	1	02	01	H3192_003_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 10:29:39 AM Eastern Daylight Time	08/03/2022 02:48:40 PM Eastern Daylight Time	07/31/2022 09:54:40 PM Eastern Daylight Time			08/04/2022 04:26:00 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	2023	MI Southeast		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			
H3192	004	0	1	02	01	H3192_004_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:26:38 AM Eastern Daylight Time	08/03/2022 02:49:36 PM Eastern Daylight Time	07/31/2022 09:55:06 PM Eastern Daylight Time			08/04/2022 04:26:00 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	2023	IN Northeast		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			
H3192	005	0	1	02	01	H3192_005_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:27:11 AM Eastern Daylight Time	08/03/2022 02:50:30 PM Eastern Daylight Time	07/31/2022 09:55:32 PM Eastern Daylight Time			08/04/2022 04:26:00 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	2023	IN Northwest		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			
H3192	006	0	1	02	01	H3192_006_0	3	1			2		1	08/04/2022	2023.01	08/04/2022 05:36:22 PM Eastern Daylight Time	08/03/2022 02:51:25 PM Eastern Daylight Time	07/31/2022 09:55:58 PM Eastern Daylight Time			08/04/2022 05:39:22 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	2023	IN Central		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			
H3192	007	0	1	01	01	H3192_007_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 05:31:34 PM Eastern Daylight Time	08/03/2022 02:52:22 PM Eastern Daylight Time	07/31/2022 09:56:24 PM Eastern Daylight Time			08/04/2022 05:39:22 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	2023	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	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:13:06 AM Eastern Daylight Time	08/03/2022 02:53:15 PM Eastern Daylight Time	07/31/2022 09:56:50 PM Eastern Daylight Time			08/04/2022 04:26:00 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	2023	IN Northwest		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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 11:38:33 AM Eastern Daylight Time	08/03/2022 02:54:10 PM Eastern Daylight Time	07/31/2022 09:57:16 PM Eastern Daylight Time			08/04/2022 04:26:00 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	2023	IN Central		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	010	0	1	02	01	H3192_010_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 10:34:17 AM Eastern Daylight Time	08/03/2022 02:55:05 PM Eastern Daylight Time	07/31/2022 09:57:42 PM Eastern Daylight Time			08/04/2022 04:26:00 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H3192	010	0	2023	MI Northern		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			
H3192	011	0	1	02	01	H3192_011_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 10:33:49 AM Eastern Daylight Time	08/03/2022 02:55:58 PM Eastern Daylight Time	07/31/2022 09:58:08 PM Eastern Daylight Time			08/04/2022 04:26:00 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H3192	011	0	2023	MI Southwest		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			
H3192	012	0	1	02	01	H3192_012_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 10:34:47 AM Eastern Daylight Time	08/03/2022 02:56:51 PM Eastern Daylight Time	07/31/2022 09:58:34 PM Eastern Daylight Time			08/04/2022 04:26:00 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H3192	012	0	2023	IN Southwest		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			
H3192	013	0	1	02	01	H3192_013_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:35:37 AM Eastern Daylight Time	08/03/2022 02:57:45 PM Eastern Daylight Time	07/31/2022 09:59:00 PM Eastern Daylight Time			08/04/2022 04:26:00 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H3192	013	0	2023	IL Northern		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			
H3192	014	0	1	02	01	H3192_014_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 11:48:17 AM Eastern Daylight Time	08/03/2022 02:58:38 PM Eastern Daylight Time	07/31/2022 09:59:26 PM Eastern Daylight Time			08/04/2022 04:26:00 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO-POS)	01	02		1			H3192	014	0	2023	IN Southwest		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			
H3192	015	0	1	02	01	H3192_015_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 11:50:00 AM Eastern Daylight Time	08/03/2022 02:59:34 PM Eastern Daylight Time	07/31/2022 09:59:52 PM Eastern Daylight Time			08/04/2022 04:26:00 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO-POS)	01	02		1			H3192	015	0	2023	IN Central		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			
H3192	017	0	1	02	01	H3192_017_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 10:36:44 AM Eastern Daylight Time	08/03/2022 03:00:29 PM Eastern Daylight Time	07/31/2022 10:00:18 PM Eastern Daylight Time			08/04/2022 04:26:00 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare MyMichigan Prime (HMO-POS)	01	02		1			H3192	017	0	2023	MI Middle		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			
H3192	801	0	1	01	01	H3192_801_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 10:31:21 AM Eastern Daylight Time					06/02/2022 03:06:29 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3192	801	0	2023	Illinois and Michigan		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3192	802	0	1	01	01	H3192_802_0	1	1						05/30/2022	2023.01	05/30/2022 10:32:24 AM Eastern Daylight Time					06/02/2022 03:06:29 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	2023	Illinois and Michigan		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3204	001	0	1	01	01	H3204_001_0	7	1			1		1	08/04/2022	2023.01	08/04/2022 02:53:37 PM Mountain Daylight Time	08/04/2022 12:58:41 PM Mountain Daylight Time	08/04/2022 12:58:42 PM Mountain Daylight Time			08/04/2022 03:08:46 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	2023	Greater Albuquerque Area, Rio Arriba and Santa Fe		2		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	7	1			1		1	07/01/2022	2023.01	07/01/2022 12:31:41 PM Mountain Daylight Time	08/04/2022 12:58:41 PM Mountain Daylight Time	08/04/2022 12:58:42 PM Mountain Daylight Time			08/04/2022 03:08:46 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	2023	Greater Albuquerque Area, Rio Arriba and Santa Fe		2		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	6	1			1	0	0	07/01/2022	2023.01	07/01/2022 12:31:16 PM Mountain Daylight Time	07/15/2022 02:29:47 PM Mountain Daylight Time				07/18/2022 02:12:52 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	2023	Greater Albuquerque Area, Rio Arriba and Santa Fe		2		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	8	1	2	1	2		0	08/04/2022	2023.01	08/04/2022 02:26:46 PM Mountain Daylight Time	08/04/2022 12:58:41 PM Mountain Daylight Time	08/04/2022 12:58:42 PM Mountain Daylight Time			08/04/2022 03:08:46 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	2023	State of New Mexico	Greater New Mexico	2		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	8	1	2	1	2		0	07/01/2022	2023.01	07/01/2022 09:04:24 AM Mountain Daylight Time	08/04/2022 12:58:41 PM Mountain Daylight Time	08/04/2022 12:58:42 PM Mountain Daylight Time			08/04/2022 03:08:46 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	2023	State of New Mexico	Chaves, Curry, Quay, Roosevelt & San Juan Counties	2		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	015	0	1	02	01	H3204_015_0	9	1			2		0	09/13/2022	2023.01	09/13/2022 09:24:31 AM Mountain Daylight Time	08/04/2022 12:58:41 PM Mountain Daylight Time	08/04/2022 12:58:42 PM Mountain Daylight Time			09/13/2022 11:56:48 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian UltraFlex (HMO-POS)	01	02		1			H3204	015	0	2023	Central NM+Curry Lincoln Quay Rio Arriba Santa Fe		2		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	801	0	1	01	01	H3204_801_0	4	1						06/16/2022	2023.01	06/16/2022 08:04:17 AM Mountain Daylight Time					06/16/2022 08:05:26 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 1 with Rx (HMO)	01	01		1			H3204	801	0	2023	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	1980	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;2;5;6;8b1;8b2;8b3;9a1;11a;11b;12;15;	2		1					1				
H3204	802	0	1	01	01	H3204_802_0	3	1				0	0	05/13/2022	2023.01	05/13/2022 02:20:31 PM Mountain Daylight Time					06/06/2022 03:56:08 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 2 (HMO)	01	01		1			H3204	802	0	2023	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	0	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;2;5;6;8b1;8b2;8b3;9a1;11a;11b;12;15;	2		1					1				
H3204	803	0	1	01	01	H3204_803_0	3	1						05/22/2022	2023.01	05/22/2022 02:42:52 PM Mountain Daylight Time					06/06/2022 03:56:08 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 3 w/ Rx NC (HMO)	01	01		1			H3204	803	0	2023	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	0	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;2;5;6;8b1;8b2;8b3;9a1;9b;11a;11b;12;15;	2		1					1				
H3204	808	0	1	02	01	H3204_808_0	4	1						06/16/2022	2023.01	06/16/2022 08:04:45 AM Mountain Daylight Time					06/16/2022 08:05:26 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 4 (HMO-POS)	01	02		1			H3204	808	0	2023	State of New Mexico		1	121401	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;2;5;6;8b1;8b2;8b3;9a1;9b;11a;11b;12;15;	2		1	1	5;6;8b1;8b2;8b3;9a1;9b;11a;11b;15;	2		1				
H3204	809	0	1	02	01	H3204_809_0	3	1				0	0	05/19/2022	2023.01	05/19/2022 09:24:27 AM Mountain Daylight Time					06/06/2022 03:56:08 PM 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	809	0	2023	State of New Mexico		1	0	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;2;5;6;8b1;8b2;8b3;9a1;9b;11a;11b;12;15;	2		1	1	5;6;8b1;8b2;8b3;9a1;9b;11a;11b;15;	2		1				
H3204	810	0	1	02	01	H3204_810_0	3	1						05/19/2022	2023.01	05/19/2022 09:24:50 AM Mountain Daylight Time					06/06/2022 03:56:08 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 6 NC (HMO-POS)	01	02		1			H3204	810	0	2023	State of New Mexico		1	0	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;2;5;6;8b1;8b2;8b3;9a1;9b;11a;11b;12;15;	2		1	1	5;6;8b1;8b2;8b3;9a1;9b;11a;11b;15;	2		1				
H3206	001	0	1	04	01	H3206_001_0	8	1						07/01/2022	2023.01	07/01/2022 09:16:05 AM Mountain Daylight Time	08/04/2022 12:58:42 PM Mountain Daylight Time	08/04/2022 12:58:42 PM Mountain Daylight Time			08/04/2022 03:08:46 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	2023	State of New Mexico		2		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	6	1				0	0	07/01/2022	2023.01	07/01/2022 09:18:25 AM Mountain Daylight Time	07/15/2022 02:29:47 PM Mountain Daylight Time				07/18/2022 02:12:52 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	2023	State of New Mexico		2		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	3	1						05/21/2022	2023.01	05/21/2022 06:47:38 PM Mountain Daylight Time					06/06/2022 03:56:08 PM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	www.phs.org/Medicare	Presbyterian MediCare PPO Emp Group Plan 1 with Rx (PPO)	01	04		1			H3206	801	0	2023	State of New Mexico		1	0	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;2;5;6;8b1;8b2;8b3;9a1;9b;11a;11b;12;15;	2		1									
H3206	802	0	1	04	01	H3206_802_0	3	1				0	0	05/21/2022	2023.01	05/21/2022 05:02:50 PM Mountain Daylight Time					06/06/2022 03:56:08 PM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	www.phs.org/Medicare	Presbyterian MediCare PPO Emp Group Plan 1 (PPO)	01	04		1			H3206	802	0	2023	State of New Mexico		1	0	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;2;5;6;8b1;8b2;8b3;9a1;9b;11a;11b;12;15;	2		1									
H3206	803	0	1	04	01	H3206_803_0	3	1						05/21/2022	2023.01	05/21/2022 06:48:40 PM Mountain Daylight Time					06/06/2022 03:56:08 PM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	www.phs.org/Medicare	Presbyterian MediCare PPO Emp Group Plan 3 + Rx NC (PPO)	01	04		1			H3206	803	0	2023	State of New Mexico		1	0	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;2;5;6;8b1;8b2;8b3;9a1;9b;11a;11b;12;15;	2		1									
H3219	001	0	1	04	01	H3219_001_0	6	1					1	08/10/2022	2023.01	08/10/2022 03:00:35 PM Eastern Daylight Time	08/04/2022 11:18:49 AM Eastern Daylight Time	07/31/2022 10:00:44 PM Eastern Daylight Time			08/10/2022 03:06:31 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	2023	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	3	1					1	08/01/2022	2023.01	08/01/2022 12:57:29 PM Central Daylight Time	08/04/2022 10:20:01 AM Central Daylight Time	07/31/2022 09:01:12 PM Central Daylight Time			08/05/2022 07:56:08 AM Central 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	2023	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	3	1					1	05/31/2022	2023.01	05/31/2022 01:00:33 PM Central Daylight Time	08/04/2022 10:22:09 AM Central Daylight Time	07/31/2022 09:02:24 PM Central Daylight Time			08/05/2022 07:56:08 AM Central 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	2023	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	05/31/2022	2023.01	05/31/2022 01:01:13 PM Central Daylight Time	08/04/2022 10:23:11 AM Central Daylight Time	07/31/2022 09:02:50 PM Central Daylight Time			08/05/2022 07:56:08 AM Central 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	2023	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	05/31/2022	2023.01	05/31/2022 01:01:51 PM Central Daylight Time	06/01/2022 11:50:53 AM Central Daylight Time				06/02/2022 10:13:25 AM Central 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	2023	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	05/30/2022	2023.01	05/30/2022 10:34:50 AM Eastern Daylight Time					06/02/2022 03:08:30 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	2023	Minnesota		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3219	802	0	1	04	01	H3219_802_0	1	1						05/30/2022	2023.01	05/30/2022 10:35:45 AM Eastern Daylight Time					06/02/2022 03:08:30 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.aetnamedicare.com	Allina Health Aetna Medicare Plan w/Rx (PPO)	01	04		1			H3219	802	0	2023	Minnesota		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3239	001	0	1	01	01	H3239_001_0	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 09:02:00 PM Eastern Daylight Time	08/03/2022 12:31:31 PM Eastern Daylight Time	07/31/2022 10:03:16 PM Eastern Daylight Time			08/04/2022 05:14:24 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	2023	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	3	1	2	1	1		0	07/22/2022	2023.01	07/22/2022 11:50:10 AM Eastern Daylight Time	08/03/2022 12:32:35 PM Eastern Daylight Time	07/31/2022 10:03:42 PM Eastern Daylight Time			08/04/2022 05:14:24 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	2023	Select Birmingham and Northern AL 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			
H3239	003	0	1	01	01	H3239_003_0	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:34:48 PM Eastern Daylight Time	08/03/2022 12:33:36 PM Eastern Daylight Time	07/31/2022 10:04:12 PM Eastern Daylight Time			08/04/2022 05:14:24 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	2023	Select Counties in Montgomery and Mobile AL 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	005	0	1	01	01	H3239_005_0	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:35:25 PM Eastern Daylight Time	08/03/2022 12:34:36 PM Eastern Daylight Time	07/31/2022 10:04:48 PM Eastern Daylight Time			08/04/2022 05:14:24 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	2023	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	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:35:53 PM Eastern Daylight Time	08/03/2022 12:35:36 PM Eastern Daylight Time	07/31/2022 10:05:18 PM Eastern Daylight Time			08/04/2022 05:14:24 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	2023	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	4	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:36:19 PM Eastern Daylight Time	08/03/2022 12:36:39 PM Eastern Daylight Time	07/31/2022 10:05:44 PM Eastern Daylight Time			08/04/2022 05:14:24 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	2023	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	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:36:38 PM Eastern Daylight Time	08/03/2022 12:37:40 PM Eastern Daylight Time	07/31/2022 10:06:10 PM Eastern Daylight Time			08/04/2022 05:14:24 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	2023	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			
H3239	010	0	1	01	01	H3239_010_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 09:45:56 PM Eastern Daylight Time	08/03/2022 12:38:45 PM Eastern Daylight Time	07/31/2022 10:06:36 PM Eastern Daylight Time			08/04/2022 05:14:24 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Select Plan (HMO D-SNP)	01	01		1			H3239	010	0	2023	Select Counties in Alabama		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	011	0	1	01	01	H3239_011_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 09:46:16 PM Eastern Daylight Time	08/03/2022 12:39:49 PM Eastern Daylight Time	07/31/2022 10:07:04 PM Eastern Daylight Time			08/04/2022 05:14:24 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Select Plan (HMO D-SNP)	01	01		1			H3239	011	0	2023	Select Counties in Louisiana		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	012	0	1	01	01	H3239_012_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 09:46:38 PM Eastern Daylight Time	08/03/2022 12:40:50 PM Eastern Daylight Time	07/31/2022 10:07:28 PM Eastern Daylight Time			08/04/2022 05:14:24 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Select Plan (HMO D-SNP)	01	01		1			H3239	012	0	2023	Select Counties in Mississippi		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	013	0	1	01	01	H3239_013_0	4	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:37:07 PM Eastern Daylight Time	08/03/2022 12:41:49 PM Eastern Daylight Time	07/31/2022 10:07:54 PM Eastern Daylight Time			08/04/2022 05:14:24 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Plus Plan (HMO D-SNP)	01	01		1			H3239	013	0	2023	Select Parishes in Louisiana		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	7	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 12:11:32 PM Eastern Daylight Time	08/04/2022 06:20:47 PM Eastern Daylight Time	08/04/2022 06:37:45 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1		1	2		0	08/02/2022	2023.01	08/02/2022 01:15:44 AM Pacific Daylight Time		08/04/2022 03:36:09 PM Pacific Daylight Time		08/04/2022 03:19:58 PM Pacific Daylight Time	08/19/2022 08:29:30 AM 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	2023	Select Counties in New Jersey		2		2			1	4			00000000100000000000000					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			1		0	05/31/2022	2023.01	05/31/2022 12:13:14 PM Eastern Daylight Time	08/04/2022 06:20:49 PM Eastern Daylight Time	08/04/2022 06:37:48 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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			2		1	08/03/2022	2023.01	08/03/2022 11:43:35 AM Eastern Daylight Time	08/04/2022 06:20:50 PM Eastern Daylight Time	08/04/2022 06:37:51 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	05/31/2022	2023.01	05/31/2022 12:19:27 PM Eastern Daylight Time	08/04/2022 06:20:52 PM Eastern Daylight Time	08/04/2022 06:37:53 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	7	1						08/03/2022	2023.01	08/03/2022 01:08:57 PM Central Daylight Time	08/05/2022 02:55:33 PM Central Daylight Time	08/03/2022 05:51:32 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	getbluenm.com/mapd	Blue Cross Medicare Advantage Select (HMO)	01	01		1			H3251	002	0	2023	New Mexico		2		2			2									getbluenm.com/mapd/pharmacies	getbluenm.com/mapd/druglist	getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	029	0	1	01	01	H3251_029_0	8	1	2	1			0	08/03/2022	2023.01	08/03/2022 01:14:05 PM Central Daylight Time	08/05/2022 02:58:01 PM Central Daylight Time	08/03/2022 05:52:52 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	getbluenm.com/dsnp	Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)	01	01		1			H3251	029	0	2023	New Mexico		2		2			1	3		2					2	getbluenm.com/dsnp/pharmacies	getbluenm.com/dsnp/druglist	getbluenm.com/dsnp/providers	(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(877)688-1813		(877)688-1813		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	030	0	1	01	01	H3251_030_0	7	1						08/05/2022	2023.01	08/05/2022 02:42:40 PM Central Daylight Time	08/05/2022 03:00:29 PM Central Daylight Time	08/03/2022 05:54:11 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	getbluenm.com/mapd	Blue Cross Medicare Advantage Dental Value (HMO)	01	01		1			H3251	030	0	2023	New Mexico		2		2			2									getbluenm.com/mapd/pharmacies	getbluenm.com/mapd/druglist	getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	804	0	1	01	01	H3251_804_0	3	1						06/02/2022	2023.01	06/02/2022 12:04:58 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	getbluenm.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3251	804	0	2023	New Mexico Statewide		1	10788	2			2									www.getbluenm.com/mapd/pharmacies	www.getbluenm.com/mapd/druglist	getbluenm.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3256	001	0	1	04	01	H3256_001_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 02:52:20 PM Central Daylight Time	08/03/2022 10:57:57 AM Central Daylight Time	07/31/2022 02:08:27 AM Central Daylight Time			08/04/2022 04:00:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice LP (PPO D-SNP)	01	04		1			H3256	001	0	2023	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	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 02:53:28 PM Central Daylight Time	08/03/2022 10:58:42 AM Central Daylight Time	07/31/2022 02:08:51 AM Central Daylight Time			08/04/2022 04:00:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP)	01	04		1			H3256	002	0	2023	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	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 01:07:16 PM Eastern Daylight Time	08/03/2022 04:30:08 PM Eastern Daylight Time	08/01/2022 03:59:10 PM Eastern Daylight Time			08/05/2022 12:55:13 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	2023	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	3	1	2	1	2		0	08/04/2022	2023.01	08/04/2022 01:05:08 PM Eastern Daylight Time	08/04/2022 11:36:18 AM Eastern Daylight Time	08/01/2022 04:06:44 PM Eastern Daylight Time			08/05/2022 12:55:13 PM 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	2023	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	003	0	1	01	01	H3259_003_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 12:58:22 PM Eastern Daylight Time	08/03/2022 05:13:22 PM Eastern Daylight Time	08/01/2022 04:14:08 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	VOLUNTEER STATE HEALTH PLAN	BlueCare Plus Tennessee	bluecareplus.bcbst.com	BlueCare Plus Select (HMO D-SNP)	01	01		1			H3259	003	0	2023	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	08/11/2022	2023.01	08/11/2022 04:42:59 PM Eastern Daylight Time	08/05/2022 09:49:54 AM Eastern Daylight Time	08/05/2022 07:18:48 AM Eastern Daylight Time			08/11/2022 05:17:36 PM Eastern Daylight Time	ALIGN SENIOR CARE CALIFORNIA INC.	Align Senior Care	www.alignseniorcare.com	Align Premier (HMO I-SNP)	01	01		1			H3274	001	0	2023	California partial		2		2			1	1	3							www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3274	002	0	1	01	01	H3274_002_0	5	1		1			1	08/04/2022	2023.01	08/04/2022 09:33:39 PM Eastern Daylight Time	08/05/2022 07:50:21 AM Mountain Daylight Time	08/05/2022 05:19:07 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	ALIGN SENIOR CARE CALIFORNIA INC.	Align Senior Care	www.alignseniorcare.com	Align Thrive (HMO I-SNP)	01	01		1			H3274	002	0	2023	California partial		2		2			1	1	3							www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3274	003	0	1	01	01	H3274_003_0	5	1		1			1	08/04/2022	2023.01	08/04/2022 09:34:20 PM Eastern Daylight Time	08/05/2022 07:50:49 AM Mountain Daylight Time	08/05/2022 05:19:25 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	ALIGN SENIOR CARE CALIFORNIA INC.	Align Senior Care	www.alignseniorcare.com	Align Connect (HMO C-SNP)	01	01		1			H3274	003	0	2023	California partial		2		2			1	4			00000100000000000000000					www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3274	004	0	1	01	01	H3274_004_0	6	1		1			1	07/12/2022	2023.01	07/12/2022 11:24:08 AM Eastern Daylight Time		08/04/2022 04:06:41 PM Eastern Daylight Time		08/04/2022 03:43:25 PM Eastern Daylight Time	08/19/2022 07:11:04 PM Eastern Daylight Time	ALIGN SENIOR CARE CALIFORNIA INC.	Align Senior Care	www.alignseniorcare.com	Align Kidney Care (HMO C-SNP)	01	01		1			H3274	004	0	2023	California (partial)		2		2			1	4			00000000100000000000000					www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(844)305-3879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3276	001	0	1	01	01	H3276_001_0	10	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 03:02:30 PM Eastern Daylight Time	08/05/2022 12:03:32 PM Eastern Daylight Time	08/05/2022 12:02:17 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	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		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3276	002	0	1	01	01	H3276_002_0	10	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 03:02:55 PM Eastern Daylight Time	08/05/2022 12:03:32 PM Eastern Daylight Time	08/05/2022 12:02:17 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	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		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3276	003	0	1	01	01	H3276_003_0	9	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 03:04:13 PM Eastern Daylight Time	08/05/2022 12:03:32 PM Eastern Daylight Time	08/05/2022 12:02:18 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	CONNECTICARE INSURANCE COMPANY, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Dual Vista (HMO D-SNP)	01	01		1			H3276	003	0	2023	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		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3284	001	0	1	20	08	H3284_001_0	1	1						06/03/2022	2023.01	06/03/2022 12:16:06 PM Pacific Daylight Time		05/31/2022 03:50:56 PM Pacific Daylight Time			06/03/2022 12:17:12 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	2023	Pierce King-Seattle Tacoma Area-WA		2		2			2									https://www.multicare.org/services-and-departments/pharmacy/	https://pnwpacepartners.wpmudev.host/												(253)459-7270				(253)459-7270												(253)459-7270				(253)459-7270																
H3284	002	0	1	20	08	H3284_002_0	1	1						06/03/2022	2023.01	06/03/2022 12:16:24 PM Pacific Daylight Time		05/31/2022 03:52:32 PM Pacific Daylight Time			06/03/2022 12:17:12 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	2023	Pierce King-Seattle Tacoma Area-WA		2		2			2									https://www.multicare.org/services-and-departments/pharmacy/	https://pnwpacepartners.wpmudev.host/												(253)459-7270				(253)459-7270												(253)459-7270				(253)459-7270																
H3288	001	0	1	04	01	H3288_001_0	2	1						05/26/2022	2023.01	05/26/2022 11:52:42 AM Central Daylight Time	08/02/2022 01:22:50 PM Central Daylight Time	07/31/2022 09:08:20 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	001	0	2023	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						05/26/2022	2023.01	05/26/2022 10:13:40 AM Eastern Daylight Time	08/02/2022 01:23:48 PM Central Daylight Time	07/31/2022 09:08:46 PM Central Daylight Time			08/04/2022 04:07:57 PM Central 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	2023	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						05/31/2022	2023.01	05/31/2022 10:17:58 AM Central Daylight Time	08/02/2022 01:24:46 PM Central Daylight Time	07/31/2022 09:09:10 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	003	0	2023	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						05/26/2022	2023.01	05/26/2022 10:34:09 AM Eastern Daylight Time	08/02/2022 01:25:54 PM Central Daylight Time	07/31/2022 09:09:38 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	004	0	2023	Austin		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(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						08/01/2022	2023.01	08/01/2022 06:00:10 PM Central Daylight Time	08/02/2022 01:27:11 PM Central Daylight Time	07/31/2022 09:10:04 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	005	0	2023	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						08/02/2022	2023.01	08/02/2022 08:42:23 AM Central Daylight Time	08/02/2022 01:28:18 PM Central Daylight Time	07/31/2022 09:10:32 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	006	0	2023	Southeast Texas 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						08/01/2022	2023.01	08/01/2022 06:03:03 PM Central Daylight Time	08/02/2022 01:29:24 PM Central Daylight Time	07/31/2022 09:10:58 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	007	0	2023	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						08/02/2022	2023.01	08/02/2022 08:58:07 AM Central Daylight Time	08/02/2022 01:30:49 PM Central Daylight Time	07/31/2022 09:11:24 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	008	0	2023	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						08/01/2022	2023.01	08/01/2022 06:06:03 PM Central Daylight Time	08/02/2022 01:32:05 PM Central Daylight Time	07/31/2022 09:11:54 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	009	0	2023	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	011	0	1	04	01	H3288_011_0	2	1						08/02/2022	2023.01	08/02/2022 08:08:22 AM Central Daylight Time	08/02/2022 01:33:27 PM Central Daylight Time	07/31/2022 09:12:20 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	011	0	2023	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	016	0	1	04	01	H3288_016_0	2	1						08/02/2022	2023.01	08/02/2022 08:51:12 AM Central Daylight Time	08/02/2022 01:34:48 PM Central Daylight Time	07/31/2022 09:12:44 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	016	0	2023	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						05/31/2022	2023.01	05/31/2022 10:24:56 AM Central Daylight Time	08/02/2022 01:36:01 PM Central Daylight Time	07/31/2022 09:13:10 PM Central Daylight Time			08/04/2022 04:07:57 PM Central 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	2023	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						05/26/2022	2023.01	05/26/2022 12:08:41 PM Eastern Daylight Time	08/02/2022 01:37:11 PM Central Daylight Time	07/31/2022 09:13:36 PM Central Daylight Time			08/04/2022 04:07:57 PM Central 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	2023	Southeast Texas 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						08/01/2022	2023.01	08/01/2022 06:08:15 PM Central Daylight Time	08/02/2022 01:38:29 PM Central Daylight Time	07/31/2022 09:14:00 PM Central Daylight Time			08/04/2022 04:07:57 PM Central 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	2023	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						08/01/2022	2023.01	08/01/2022 06:09:42 PM Central Daylight Time	08/02/2022 01:40:30 PM Central Daylight Time	07/31/2022 09:14:26 PM Central Daylight Time			08/04/2022 04:07:57 PM Central 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	2023	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						08/01/2022	2023.01	08/01/2022 06:11:24 PM Central Daylight Time	08/02/2022 01:42:42 PM Central Daylight Time	07/31/2022 09:14:52 PM Central Daylight Time			08/04/2022 04:07:57 PM Central 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	2023	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	023	0	1	04	01	H3288_023_0	3	1						08/10/2022	2023.01	08/10/2022 03:12:11 PM Eastern Daylight Time	08/03/2022 12:42:47 PM Eastern Daylight Time	07/31/2022 10:15:18 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:12:40 PM Eastern Daylight Time	08/03/2022 12:43:47 PM Eastern Daylight Time	07/31/2022 10:15:44 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	2	1						08/02/2022	2023.01	08/02/2022 06:07:25 PM Eastern Daylight Time	08/03/2022 12:44:47 PM Eastern Daylight Time	07/31/2022 10:16:08 PM Eastern Daylight Time			08/04/2022 05:28:00 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:13:03 PM Eastern Daylight Time	08/03/2022 12:45:48 PM Eastern Daylight Time	07/31/2022 10:16:34 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:13:38 PM Eastern Daylight Time	08/03/2022 12:46:48 PM Eastern Daylight Time	07/31/2022 10:17:00 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:14:15 PM Eastern Daylight Time	08/03/2022 12:48:36 PM Eastern Daylight Time	07/31/2022 10:17:26 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:14:44 PM Eastern Daylight Time	08/03/2022 12:49:49 PM Eastern Daylight Time	07/31/2022 10:17:50 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:15:09 PM Eastern Daylight Time	08/03/2022 12:51:08 PM Eastern Daylight Time	07/31/2022 10:18:16 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:15:41 PM Eastern Daylight Time	08/03/2022 12:52:16 PM Eastern Daylight Time	07/31/2022 10:18:42 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:16:08 PM Eastern Daylight Time	08/03/2022 12:53:18 PM Eastern Daylight Time	07/31/2022 10:19:08 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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						08/10/2022	2023.01	08/10/2022 03:16:34 PM Eastern Daylight Time	08/03/2022 12:54:38 PM Eastern Daylight Time	07/31/2022 10:19:34 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	05/31/2022	2023.01	05/31/2022 07:34:45 PM Eastern Daylight Time	06/01/2022 02:04:57 PM Eastern Daylight Time				06/02/2022 01:30:47 PM 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	2023	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	042	0	1	04	01	H3288_042_0	3	1						08/10/2022	2023.01	08/10/2022 03:17:04 PM Eastern Daylight Time	08/03/2022 12:57:31 PM Eastern Daylight Time	07/31/2022 10:20:00 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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	045	0	1	04	01	H3288_045_0	3	1						08/10/2022	2023.01	08/10/2022 03:17:32 PM Eastern Daylight Time	08/03/2022 12:58:40 PM Eastern Daylight Time	07/31/2022 10:20:26 PM Eastern Daylight Time			08/10/2022 03:40:26 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	2023	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						08/02/2022	2023.01	08/02/2022 08:53:52 AM Central Daylight Time	08/02/2022 01:45:32 PM Central Daylight Time	07/31/2022 09:20:52 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	046	0	2023	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						08/01/2022	2023.01	08/01/2022 06:13:24 PM Central Daylight Time	08/02/2022 01:49:02 PM Central Daylight Time	07/31/2022 09:21:18 PM Central Daylight Time			08/04/2022 04:07:57 PM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H3288	047	0	2023	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						05/31/2022	2023.01	05/31/2022 10:30:11 AM Central Daylight Time	08/02/2022 01:52:02 PM Central Daylight Time	07/31/2022 09:21:42 PM Central Daylight Time			08/04/2022 04:07:57 PM Central 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	2023	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	05/31/2022	2023.01	05/31/2022 10:31:51 AM Central Daylight Time	08/02/2022 01:53:15 PM Central Daylight Time				08/05/2022 09:49:14 AM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H3288	049	0	2023	Dallas and Tarrant 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3288	050	0	1	04	01	H3288_050_0	2	1				0	0	05/31/2022	2023.01	05/31/2022 10:32:49 AM Central Daylight Time	08/02/2022 01:54:15 PM Central Daylight Time				08/05/2022 09:49:14 AM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H3288	050	0	2023	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	2	1				0	0	05/31/2022	2023.01	05/31/2022 10:34:50 AM Central Daylight Time	08/02/2022 01:55:14 PM Central Daylight Time				08/05/2022 09:49:14 AM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H3288	051	0	2023	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	05/31/2022	2023.01	05/31/2022 04:23:52 PM Central Daylight Time	08/02/2022 01:56:15 PM Central Daylight Time				08/05/2022 09:49:14 AM Central Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H3288	052	0	2023	Bexar		2		2			2									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	05/30/2022	2023.01	05/30/2022 10:41:59 AM Eastern Daylight Time					06/02/2022 03:10:05 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	2023	Multi-State		1	120	2			2									https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3288	802	0	1	04	01	H3288_802_0	1	1						05/30/2022	2023.01	05/30/2022 10:42:25 AM Eastern Daylight Time					06/02/2022 03:10:05 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	2023	Multi-State		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3291	001	0	1	01	01	H3291_001_0	7	1		1				08/02/2022	2023.01	08/02/2022 08:50:54 PM Central Daylight Time	08/03/2022 11:38:07 AM Central Daylight Time	08/02/2022 11:10:30 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	PRUITTHEALTH PREMIER, INC.	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier (HMO I-SNP)	01	01		1			H3291	001	0	2023	Georgia (partial)		2		2			1	1	3							www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3291	002	0	1	01	01	H3291_002_0	7	1	2	1			0	08/11/2022	2023.01	08/11/2022 11:52:35 AM Central Daylight Time	08/03/2022 11:38:41 AM Central Daylight Time	08/02/2022 11:11:57 AM Central Daylight Time			08/11/2022 01:06:56 PM Central Daylight Time	PRUITTHEALTH PREMIER, INC.	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier D-SNP (HMO D-SNP)	01	01		1			H3291	002	0	2023	Georgia (partial)		2		2			1	3		2					1	www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(855)855-0668		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3305	007	0	1	02	01	H3305_007_0	7	1				0	0	07/21/2022	2023.01	07/21/2022 12:47:44 PM Eastern Daylight Time	07/20/2022 09:57:28 AM Eastern Daylight Time				07/22/2022 11:44:23 AM 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	2023	Western NY (Rochester/Buffalo)		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										(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					1	08/03/2022	2023.01	08/03/2022 12:52:40 PM Eastern Daylight Time	08/04/2022 11:57:22 AM Eastern Daylight Time	08/03/2022 03:18:18 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	Western NY (Rochester/Buffalo)		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	2			
H3305	020	0	1	02	01	H3305_020_0	6	1				0	0	07/13/2022	2023.01	07/13/2022 11:15:47 AM Eastern Daylight Time	06/05/2022 03:01:14 PM Eastern Daylight Time				07/18/2022 03:43:54 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	2023	S.Tier NY, CNY, Eastern NY, Hudson Valley NY, VT		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										(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	8	1					1	08/03/2022	2023.01	08/03/2022 12:54:47 PM Eastern Daylight Time	08/04/2022 11:58:10 AM Eastern Daylight Time	08/03/2022 03:18:36 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	S.Tier NY, CNY, Eastern NY, Hudson Valley 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	2			
H3305	022	0	1	02	01	H3305_022_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:00:07 PM Eastern Daylight Time	08/04/2022 11:58:32 AM Eastern Daylight Time	08/03/2022 03:18:54 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	S.Tier NY, CNY, Eastern NY, Hudson Valley NY, VT		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	2			
H3305	030	0	1	02	01	H3305_030_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:02:47 PM Eastern Daylight Time	08/04/2022 11:58:56 AM Eastern Daylight Time	08/05/2022 12:44:16 PM Eastern Daylight Time			08/05/2022 03:47:24 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	2023	Western NY (Rochester/Buffalo)		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	2			
H3305	032	0	1	02	01	H3305_032_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:07:46 PM Eastern Daylight Time	08/04/2022 11:59:20 AM Eastern Daylight Time	08/03/2022 03:19:16 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	S.Tier NY, CNY, Eastern NY, Hudson Valley 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	2			
H3305	033	0	1	01	01	H3305_033_0	8	1	2	1			0	08/01/2022	2023.01	08/01/2022 01:48:12 PM Eastern Daylight Time	08/04/2022 11:59:42 AM Eastern Daylight Time	08/03/2022 03:19:36 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	Western NY, Eastern NY, Hudson Valley, NY		2		2			1	3		1					1	https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(866)954-1872		(866)954-1872		(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	034	0	1	01	01	H3305_034_0	8	1	2	1			0	08/01/2022	2023.01	08/01/2022 01:52:00 PM Eastern Daylight Time	08/04/2022 12:00:06 PM Eastern Daylight Time	08/03/2022 03:19:54 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	Western NY, Eastern NY, Hudson Valley, NY		2		2			1	3		1					1	https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(866)954-1872		(866)954-1872		(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	035	0	1	01	01	H3305_035_0	8	1	2	1			0	08/01/2022	2023.01	08/01/2022 01:56:27 PM Eastern Daylight Time	08/05/2022 01:06:08 PM Eastern Daylight Time	08/03/2022 03:20:12 PM Eastern Daylight Time			08/05/2022 03:47:24 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	2023	Western NY, Eastern NY, Hudson Valley, NY		2		2			1	3		1					1	https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(866)954-1872		(866)954-1872		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	801	0	1	02	01	H3305_801_0	4	1				0	0	05/18/2022	2023.01	05/18/2022 05:07:08 PM Eastern Daylight Time					06/06/2022 02:21:56 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	2023	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	4	1						05/18/2022	2023.01	05/18/2022 05:07:50 PM Eastern Daylight Time					06/06/2022 02:21:56 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	2023	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	4	1						05/18/2022	2023.01	05/18/2022 05:08:30 PM Eastern Daylight Time					06/06/2022 02:21:56 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	2023	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	02	01	H3307_002_0	2	1					1	05/31/2022	2023.01	05/31/2022 05:48:27 PM Central Daylight Time	08/03/2022 11:35:32 AM Central Daylight Time	07/31/2022 02:09:16 AM Central Daylight Time			08/04/2022 04:52:50 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H3307	002	0	2023	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	02	01	H3307_012_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:22:59 PM Central Daylight Time	08/03/2022 11:36:14 AM Central Daylight Time	07/31/2022 02:09:40 AM Central Daylight Time			08/04/2022 04:52:50 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H3307	012	0	2023	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	02	01	H3307_015_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:23:18 PM Central Daylight Time	08/03/2022 11:36:55 AM Central Daylight Time	07/31/2022 02:10:04 AM Central Daylight Time			08/04/2022 04:52:50 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Prime (HMO-POS)	01	02		1			H3307	015	0	2023	Kings, New York, and Queens Counties		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	02	01	H3307_018_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 05:57:37 PM Central Daylight Time	06/01/2022 12:11:32 PM Central Daylight Time				06/02/2022 02:43:40 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H3307	018	0	2023	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	02	01	H3307_023_0	2	1					1	05/31/2022	2023.01	05/31/2022 05:59:39 PM Central Daylight Time	08/03/2022 11:38:19 AM Central Daylight Time	07/31/2022 02:10:29 AM Central Daylight Time			08/04/2022 04:52:50 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H3307	023	0	2023	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	02	01	H3307_025_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:23:42 PM Central Daylight Time	08/03/2022 11:39:01 AM Central Daylight Time	07/31/2022 02:10:53 AM Central Daylight Time			08/04/2022 04:52:50 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H3307	025	0	2023	Select Counties in New York		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(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						06/03/2022	2023.01	06/03/2022 09:52:00 AM Central Daylight Time					06/03/2022 03:21:15 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	802	0	2023	New York Metropolitan Area		1	3600	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	06/03/2022	2023.01	06/03/2022 09:52:17 AM Central Daylight Time					06/03/2022 03:21:15 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	804	0	2023	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						06/03/2022	2023.01	06/03/2022 09:52:31 AM Central Daylight Time					06/03/2022 03:21:15 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	805	0	2023	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			08/02/2022	2023.01	08/02/2022 01:21:12 PM Eastern Daylight Time	08/02/2022 05:39:05 PM Eastern Daylight Time	07/31/2022 10:22:08 PM Eastern Daylight Time			08/04/2022 04:40:05 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	002	0	2023	Metro Area: Bronx, Brooklyn, 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	2			
H3312	018	0	1	01	01	H3312_018_0	2	1			2			05/31/2022	2023.01	05/31/2022 11:54:32 AM Eastern Daylight Time	08/02/2022 05:40:03 PM Eastern Daylight Time	07/31/2022 10:22:34 PM Eastern Daylight Time			08/04/2022 04:40:05 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	018	0	2023	Westchester and Rockland 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	2			
H3312	048	0	1	01	01	H3312_048_0	2	1			2			08/02/2022	2023.01	08/02/2022 03:26:22 PM Eastern Daylight Time	08/03/2022 10:50:29 AM Eastern Daylight Time	07/31/2022 10:23:00 PM Eastern Daylight Time			08/04/2022 04:40:05 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	048	0	2023	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	2			
H3312	062	0	1	02	01	H3312_062_0	3	1			2			08/02/2022	2023.01	08/02/2022 01:24:21 PM Eastern Daylight Time	08/02/2022 05:42:04 PM Eastern Daylight Time	07/31/2022 10:23:24 PM Eastern Daylight Time			08/04/2022 04:40:05 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	2023	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	2			
H3312	064	0	1	01	01	H3312_064_0	3	1			2			06/06/2022	2023.01	06/06/2022 12:00:14 PM Eastern Daylight Time	08/02/2022 05:43:02 PM Eastern Daylight Time	07/31/2022 10:23:52 PM Eastern Daylight Time			08/04/2022 04:40:05 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	064	0	2023	Nassau and 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	2			
H3312	065	0	1	02	01	H3312_065_0	2	1			2			08/02/2022	2023.01	08/02/2022 01:30:31 PM Eastern Daylight Time	08/02/2022 05:43:59 PM Eastern Daylight Time	07/31/2022 10:24:20 PM Eastern Daylight Time			08/04/2022 04:40:05 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	2023	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	2			
H3312	069	0	1	01	01	H3312_069_0	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 03:56:49 PM Eastern Daylight Time	08/02/2022 05:44:56 PM Eastern Daylight Time	07/31/2022 10:24:44 PM Eastern Daylight Time			08/04/2022 04:40:05 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	2023	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	(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			
H3312	070	0	1	01	01	H3312_070_0	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:01:03 PM Eastern Daylight Time	08/02/2022 05:45:57 PM Eastern Daylight Time	07/31/2022 10:25:10 PM Eastern Daylight Time			08/04/2022 04:40:05 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	2023	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	(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			
H3312	072	0	1	01	01	H3312_072_0	3	1			2			08/02/2022	2023.01	08/02/2022 03:02:30 PM Eastern Daylight Time	08/02/2022 05:46:53 PM Eastern Daylight Time	07/31/2022 10:25:36 PM Eastern Daylight Time			08/04/2022 04:40:05 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	072	0	2023	Metro: New York, 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	2			
H3312	073	0	1	01	01	H3312_073_0	3	1	2	1	1		0	05/27/2022	2023.01	05/27/2022 01:38:52 PM Eastern Daylight Time	08/02/2022 05:47:50 PM Eastern Daylight Time	07/31/2022 10:26:02 PM Eastern Daylight Time			08/04/2022 04:40:05 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus Plan (HMO D-SNP)	01	01		1			H3312	073	0	2023	Metro Brooklyn		2		2			1	3		1					1	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			
H3312	801	0	1	01	01	H3312_801_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 09:49:52 AM Eastern Daylight Time					06/02/2022 03:11:57 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3312	801	0	2023	New York		1	620	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3312	804	0	1	01	01	H3312_804_0	1	1						05/30/2022	2023.01	05/30/2022 09:49:03 AM Eastern Daylight Time					06/02/2022 03:11:57 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	2023	New York		1	1500	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3321	001	0	1	20	08	H3321_001_0	1	1						06/01/2022	2023.01	06/01/2022 01:08:04 PM Eastern Daylight Time		06/01/2022 01:32:43 PM Eastern Daylight Time			06/01/2022 01:36:24 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	2023	Onondaga County		2		2			2									www.loretto-cny.org	Independent Living Services of Central New York, Inc										(888)728-7223		(315)452-5800		(888)728-7223		(315)452-5800										(800)662-1220		(315)452-5800		(800)662-1220		(315)452-5800																
H3321	003	0	1	20	08	H3321_003_0	1	1						06/01/2022	2023.01	06/01/2022 01:09:19 PM Eastern Daylight Time		06/01/2022 01:32:53 PM Eastern Daylight Time			06/01/2022 01:36:24 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	2023	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						06/01/2022	2023.01	06/01/2022 01:08:04 PM Eastern Daylight Time		05/27/2022 12:48:47 PM Eastern Daylight Time			06/01/2022 01:11:15 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	2023	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						06/01/2022	2023.01	06/01/2022 01:09:11 PM Eastern Daylight Time		05/27/2022 12:51:12 PM Eastern Daylight Time			06/01/2022 01:11:15 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	2023	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	1	1						06/01/2022	2023.01	06/01/2022 01:23:56 PM Eastern Daylight Time		06/01/2022 01:15:31 PM Eastern Daylight Time			06/01/2022 01:29:37 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	2023	NYC  and Westchester Counties		2		2			2									N/A	N/A										(877)226-8500		(347)501-2901		(877)226-8500		(347)640-6039										(711)-		(711)-		(711)-		(711)-																
H3329	002	0	1	20	08	H3329_002_0	1	1						06/01/2022	2023.01	06/01/2022 01:27:43 PM Eastern Daylight Time		06/01/2022 01:15:39 PM Eastern Daylight Time			06/01/2022 01:29:37 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	2023	NYC and Westchester Counties		2		2			2									N/A	N/A										(877)226-8500		(347)501-2901		(877)226-8500		(347)640-6039										(711)-		(711)-		(711)-		(711)-																
H3330	021	1	1	01	01	H3330_021_1	10	1			2		1	07/18/2022	2023.01	07/18/2022 05:00:20 PM Eastern Daylight Time	08/05/2022 12:03:32 PM Eastern Daylight Time	08/05/2022 12:02:18 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	1	2023	New York City, Long Island, Hudson Valley	Bronx, Kings, New York, Queens	2		2			2									emblemhealth.com	www.emblemhealth.com/resources/pharmacy/medicare-drugs-covered	www.emblemhealth.com/providers?segid=SEGA1000440	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	021	2	1	01	01	H3330_021_2	10	1			2		1	06/06/2022	2023.01	06/06/2022 10:16:17 AM Eastern Daylight Time	08/05/2022 12:03:32 PM Eastern Daylight Time	08/05/2022 12:02:18 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	2	2023	New York City, Long Island, Hudson Valley	Nassau, Richmond	2		2			2									emblemhealth.com	www.emblemhealth.com/resources/pharmacy/medicare-drugs-covered	www.emblemhealth.com/providers?segid=SEGA1000440	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	021	3	1	01	01	H3330_021_3	11	1			2		1	06/06/2022	2023.01	06/06/2022 10:16:28 AM Eastern Daylight Time	08/05/2022 12:03:33 PM Eastern Daylight Time	08/05/2022 12:02:18 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	3	2023	New York City, Long Island, Hudson Valley	Suffolk	2		2			2									emblemhealth.com	www.emblemhealth.com/resources/pharmacy/medicare-drugs-covered	www.emblemhealth.com/providers?segid=SEGA1000440	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	021	4	1	01	01	H3330_021_4	10	1			2		1	06/06/2022	2023.01	06/06/2022 10:16:39 AM Eastern Daylight Time	08/05/2022 12:03:33 PM Eastern Daylight Time	08/05/2022 12:02:18 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	4	2023	New York City, Long Island, Hudson Valley	Hudson Valley	2		2			2									emblemhealth.com	www.emblemhealth.com/resources/pharmacy/medicare-drugs-covered	www.emblemhealth.com/providers?segid=SEGA1000440	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	2	1	01	01	H3330_032_2	11	1			2		0	07/14/2022	2023.01	07/14/2022 08:53:05 AM Eastern Daylight Time	08/05/2022 12:03:33 PM Eastern Daylight Time	08/05/2022 12:02:18 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	Long Island, Hudson Valley	Nassau, Richmond	2		2			2									emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	3	1	01	01	H3330_032_3	10	1			2		0	08/04/2022	2023.01	08/04/2022 02:55:41 PM Eastern Daylight Time	08/05/2022 12:03:33 PM Eastern Daylight Time	08/05/2022 12:02:18 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	Long Island, Hudson Valley	Suffolk	2		2			2									emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	4	1	01	01	H3330_032_4	11	1			2		0	07/14/2022	2023.01	07/14/2022 08:53:30 AM Eastern Daylight Time	08/05/2022 12:03:33 PM Eastern Daylight Time	08/05/2022 12:02:18 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	Long Island, Hudson Valley	Hudson Valley	2		2			2									emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	038	0	1	01	01	H3330_038_0	11	1			2		1	06/06/2022	2023.01	06/06/2022 10:21:56 AM Eastern Daylight Time	08/05/2022 12:03:33 PM Eastern Daylight Time	08/05/2022 12:02:18 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	New York City, Long Island, Hudson Valley		2		2			2									emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	042	1	1	01	01	H3330_042_1	11	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 03:04:30 PM Eastern Daylight Time	08/05/2022 12:03:33 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	NYC, Long Island, Hudson Valley, Capital Region	Bronx, Kings, New York, Queens	2		2			1	3		1					1	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	042	2	1	01	01	H3330_042_2	11	1	2	1	1		0	06/29/2022	2023.01	06/29/2022 08:35:07 AM Eastern Daylight Time	08/05/2022 12:03:33 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	NYC, Long Island, Hudson Valley, Capital Region	Suffolk	2		2			1	3		1					1	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	042	3	1	01	01	H3330_042_3	11	1	2	1	1		0	06/29/2022	2023.01	06/29/2022 08:36:20 AM Eastern Daylight Time	08/05/2022 12:03:31 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	NYC, Long Island, Hudson Valley, Capital Region	Hudson Valley, Capital Region	2		2			1	3		1					1	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	045	0	1	01	01	H3330_045_0	11	1			2		0	08/04/2022	2023.01	08/04/2022 02:57:05 PM Eastern Daylight Time	08/05/2022 12:03:31 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Rx Saver (HMO)	01	01		1			H3330	045	0	2023	Capital Region		2		2			2									emblemhealth.com	www.emblemhealth.com/resources/pharmacy/medicare-drugs-covered	www.emblemhealth.com/providers?segid=SEGA1000440	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	046	0	1	01	01	H3330_046_0	12	1			2		0	08/04/2022	2023.01	08/04/2022 02:57:42 PM Eastern Daylight Time	08/05/2022 12:03:31 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Reserve Classic (HMO)	01	01		1			H3330	046	0	2023	Bronx, Kings, New York, Queens		2		2			2									emblemhealth.com	www.emblemhealth.com/resources/pharmacy/medicare-drugs-covered	www.emblemhealth.com/providers?segid=SEGA1000440	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	814	0	1	01	01	H3330_814_0	8	1						06/03/2022	2023.01	06/03/2022 08:18:29 AM Eastern Daylight Time					06/06/2022 05:17:28 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	2023	New York		1	185592	2			2									emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-3;3-4;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;16b;	1	7d;7f;7i;18a;	1					1				
H3330	815	0	1	01	01	H3330_815_0	8	1				0	0	05/31/2022	2023.01	05/31/2022 05:05:49 PM Eastern Daylight Time					06/06/2022 05:17:28 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	2023	New York		1	184488	2			2									emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-3;3-4;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;16b;	1	7d;7f;7i;18a;	1					1				
H3330	820	0	1	02	01	H3330_820_0	8	1						05/31/2022	2023.01	05/31/2022 04:59:03 PM Eastern Daylight Time					06/06/2022 05:17:28 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	2023	New York		1	200	2			2									emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-3;3-4;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;16b;	1	7d;7f;7i;18a;	1	1	1a;1b;2;3-3;3-4;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;16b;	1	7d;7f;7i;18a;	1				
H3330	821	0	1	02	01	H3330_821_0	8	1				0	0	05/31/2022	2023.01	05/31/2022 04:53:36 PM Eastern Daylight Time					06/06/2022 05:17:28 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	2023	New York		1	200	2			2									emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-3;3-4;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;16b;	1	7d;7f;7i;18a;	1	1	1a;1b;2;3-3;3-4;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;16b;	1	7d;7f;7i;18a;	1				
H3331	001	0	1	20	08	H3331_001_0	1	1						05/27/2022	2023.01	05/27/2022 09:43:35 AM Eastern Daylight Time		05/27/2022 09:27:57 AM Eastern Daylight Time			05/27/2022 09:46:21 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	2023	Monroe, Wayne, Ontario Counties		2		2			2									www.rochestergeneral.org/hillhaven	www.rochestergeneral.org										(855)457-4636		(585)922-2831		(855)457-4636		(585)922-2831										(800)662-1220		(585)922-2831		(800)662-1220		(585)922-2831																
H3331	002	0	1	20	08	H3331_002_0	1	1						05/27/2022	2023.01	05/27/2022 09:44:01 AM Eastern Daylight Time		05/27/2022 09:28:29 AM Eastern Daylight Time			05/27/2022 09:46:21 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	2023	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	015	0	1	04	01	H3335_015_0	7	1					1	08/05/2022	2023.01	08/05/2022 12:38:48 PM Eastern Daylight Time	08/03/2022 01:38:32 PM Eastern Daylight Time	07/31/2022 11:56:32 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEnhanced (PPO)	01	04		1			H3335	015	0	2023	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	08/05/2022	2023.01	08/05/2022 12:38:52 PM Eastern Daylight Time	08/03/2022 01:39:02 PM Eastern Daylight Time	07/31/2022 11:56:54 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BluePlus (PPO)	01	04		1			H3335	018	0	2023	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	8	1					1	08/05/2022	2023.01	08/05/2022 12:25:48 PM Eastern Daylight Time	08/03/2022 01:39:32 PM Eastern Daylight Time	07/31/2022 11:57:14 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueClassic (PPO)	01	04		1			H3335	038	0	2023	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	5	1				0	0	07/14/2022	2023.01	07/14/2022 04:00:53 PM Eastern Daylight Time	06/06/2022 11:24:12 AM Eastern Daylight Time				07/15/2022 10:52:47 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueSalute (PPO)	01	04		1			H3335	043	0	2023	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	5	1				0	0	07/14/2022	2023.01	07/14/2022 04:01:24 PM Eastern Daylight Time	06/06/2022 11:24:44 AM Eastern Daylight Time				07/15/2022 10:52:47 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueSalute (PPO)	01	04		1			H3335	044	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 12:24:44 PM Eastern Daylight Time	08/03/2022 01:40:04 PM Eastern Daylight Time	07/31/2022 11:57:36 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEssential (PPO)	01	04		1			H3335	053	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 12:23:52 PM Eastern Daylight Time	08/03/2022 01:40:34 PM Eastern Daylight Time	07/31/2022 11:57:58 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueActive (PPO)	01	04		1			H3335	055	0	2023	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	056	0	1	04	01	H3335_056_0	7	1					1	08/05/2022	2023.01	08/05/2022 12:37:16 PM Eastern Daylight Time	08/03/2022 01:41:10 PM Eastern Daylight Time	07/31/2022 11:58:18 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Access (PPO)	01	04		1			H3335	056	0	2023	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			
H3335	057	0	1	04	01	H3335_057_0	7	1					1	08/05/2022	2023.01	08/05/2022 12:37:07 PM Eastern Daylight Time	08/03/2022 01:41:40 PM Eastern Daylight Time	07/31/2022 11:58:40 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Access (PPO)	01	04		1			H3335	057	0	2023	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			
H3335	058	0	1	04	01	H3335_058_0	7	1					1	08/05/2022	2023.01	08/05/2022 12:25:05 PM Eastern Daylight Time	08/03/2022 01:42:10 PM Eastern Daylight Time	07/31/2022 11:59:00 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueFlex (PPO)	01	04		1			H3335	058	0	2023	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						05/31/2022	2023.01	05/31/2022 07:29:56 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	Western New York		1	2220	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						05/31/2022	2023.01	05/31/2022 07:30:14 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	National and Puerto Rico		1	128556	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	05/31/2022	2023.01	05/31/2022 07:30:23 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	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	05/31/2022	2023.01	05/31/2022 07:30:34 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	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						05/31/2022	2023.01	05/31/2022 07:30:41 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	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						05/22/2022	2023.01	05/22/2022 04:51:05 PM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 09:59:18 AM Eastern Daylight Time	08/04/2022 06:18:02 PM Eastern Daylight Time	08/04/2022 06:32:25 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 09:59:35 AM Eastern Daylight Time	08/04/2022 06:18:03 PM Eastern Daylight Time	08/04/2022 06:32:28 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	3	1						05/23/2022	2023.01	05/23/2022 03:11:30 PM Pacific Daylight Time					06/03/2022 10:25:36 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	2023	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;15;16b;18a;	2		1									
H3342	809	0	1	04	01	H3342_809_0	3	1				0	0	05/23/2022	2023.01	05/23/2022 03:11:35 PM Pacific Daylight Time					06/03/2022 10:25:36 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	2023	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;15;16b;18a;	2		1									
H3344	005	0	1	04	01	H3344_005_0	5	1					1	08/03/2022	2023.01	08/03/2022 09:15:37 AM Eastern Daylight Time	08/03/2022 12:16:58 PM Eastern Daylight Time	08/03/2022 11:21:46 AM Eastern Daylight Time			08/05/2022 09:33:16 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare Passport Advantage (PPO)	01	04		1			H3344	005	0	2023	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	5	1					1	08/03/2022	2023.01	08/03/2022 09:17:39 AM Eastern Daylight Time	08/03/2022 04:25:54 PM Eastern Daylight Time	08/03/2022 11:23:40 AM Eastern Daylight Time			08/05/2022 09:33:16 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare Passport Prime (PPO)	01	04		1			H3344	010	0	2023	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						06/03/2022	2023.01	06/03/2022 08:23:21 AM Eastern Daylight Time					06/06/2022 09:33:31 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare PPO Base (PPO)	01	04		1			H3344	801	0	2023	IH Network and Medicare Deemed Network		1	20532	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	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;16b;	2		1									
H3344	804	0	1	04	01	H3344_804_0	2	1				0	0	06/01/2022	2023.01	06/01/2022 11:22:09 AM Eastern Daylight Time					06/06/2022 09:33:31 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare PPO Base (PPO)	01	04		1			H3344	804	0	2023	IH Network and Medicare Deemed Network		1	17629	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	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;16b;	2		1									
H3344	805	0	1	04	01	H3344_805_0	2	1						06/01/2022	2023.01	06/01/2022 11:26:42 AM Eastern Daylight Time					06/06/2022 09:33:31 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare PPO Base (PPO)	01	04		1			H3344	805	0	2023	National Service Area		1	17947	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	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;16b;	2		1									
H3347	002	0	1	01	01	H3347_002_0	3	1	2	1			0	08/03/2022	2023.01	08/03/2022 11:09:31 AM Eastern Daylight Time	08/02/2022 03:52:58 PM Eastern Daylight Time	08/02/2022 02:19:22 PM Eastern Daylight Time			08/03/2022 05:41:33 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan For Medicaid Beneficiaries (HMO D-SNP)	01	01		1			H3347	002	0	2023	Brx, Ki, Na, NY, Qu, Wes		2		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	3	1		1				08/03/2022	2023.01	08/03/2022 11:10:41 AM Eastern Daylight Time	08/02/2022 01:43:04 PM Eastern Daylight Time	08/02/2022 02:19:58 PM Eastern Daylight Time			08/03/2022 05:41:33 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Advantage For Nursing Home Residents (HMO I-SNP)	01	01		1			H3347	003	0	2023	Select Counties In New York State		2		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	3	1	2	1			0	08/03/2022	2023.01	08/03/2022 11:26:37 AM Eastern Daylight Time	08/02/2022 03:53:58 PM Eastern Daylight Time	08/02/2022 02:22:30 PM Eastern Daylight Time			08/03/2022 05:41:33 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Plus Long Term Care (HMO D-SNP)	01	01		1			H3347	007	0	2023	Brx, Dut, Ki, Na, NY, Ora, Put, Qu, Ri, Roc, Wes		2		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	3	1						08/03/2022	2023.01	08/03/2022 11:41:35 AM Eastern Daylight Time	08/02/2022 01:44:56 PM Eastern Daylight Time	08/02/2022 02:23:06 PM Eastern Daylight Time			08/03/2022 05:41:33 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Extra Help (HMO)	01	01		1			H3347	009	0	2023	Brx, Ki, NY, Qu, Wes		2		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	3	1		1				08/03/2022	2023.01	08/03/2022 11:42:31 AM Eastern Daylight Time	08/02/2022 01:45:58 PM Eastern Daylight Time	08/02/2022 02:23:48 PM Eastern Daylight Time			08/03/2022 05:41:33 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Assist (HMO I-SNP)	01	01		1			H3347	015	0	2023	Select Counties In New York State		2		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			
H3347	016	0	1	01	01	H3347_016_0	4	1						08/03/2022	2023.01	08/03/2022 11:48:56 AM Eastern Daylight Time	08/02/2022 03:54:40 PM Eastern Daylight Time	08/02/2022 02:24:36 PM Eastern Daylight Time			08/03/2022 05:41:33 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Flex (HMO)	01	01		1			H3347	016	0	2023	Brx, Ki, NY, Qu, Wes		2		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)-		(771)-		(711)-		(771)-		(711)-		(771)-		(711)-		(771)-		2					2					2	2			
H3351	001	0	1	02	01	H3351_001_0	5	1				0	0	07/14/2022	2023.01	07/14/2022 04:26:55 PM Eastern Daylight Time	06/06/2022 11:27:50 AM Eastern Daylight Time				07/15/2022 10:52:47 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera Medicare Freedom (HMO-POS)	01	02		1			H3351	001	0	2023	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	08/05/2022	2023.01	08/05/2022 12:39:33 PM Eastern Daylight Time	08/03/2022 01:42:42 PM Eastern Daylight Time	07/31/2022 11:59:22 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Secure (HMO-POS)	01	02		1			H3351	002	0	2023	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	08/05/2022	2023.01	08/05/2022 12:39:38 PM Eastern Daylight Time	08/03/2022 01:43:14 PM Eastern Daylight Time	07/31/2022 11:59:42 AM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Optimum (HMO-POS)	01	02		1			H3351	006	0	2023	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	5	1				0	0	07/14/2022	2023.01	07/14/2022 04:27:33 PM Eastern Daylight Time	06/06/2022 11:29:22 AM Eastern Daylight Time				07/15/2022 10:52:47 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Freedom (HMO-POS)	01	02		1			H3351	007	0	2023	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	012	0	1	02	01	H3351_012_0	8	1					1	08/05/2022	2023.01	08/05/2022 12:26:22 PM Eastern Daylight Time	08/08/2022 03:00:42 PM Eastern Daylight Time	07/31/2022 12:00:04 PM Eastern Daylight Time			08/09/2022 02:58:57 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Value Plus (HMO-POS)	01	02		1			H3351	012	0	2023	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	8	1					1	08/05/2022	2023.01	08/05/2022 12:27:44 PM Eastern Daylight Time	08/08/2022 03:04:58 PM Eastern Daylight Time	07/31/2022 12:00:26 PM Eastern Daylight Time			08/09/2022 02:58:57 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Value Plus (HMO-POS)	01	02		1			H3351	013	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 12:39:47 PM Eastern Daylight Time	08/03/2022 01:44:46 PM Eastern Daylight Time	07/31/2022 12:00:46 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Bassett (HMO-POS)	01	02		1			H3351	015	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 12:26:56 PM Eastern Daylight Time	08/03/2022 01:45:18 PM Eastern Daylight Time	07/31/2022 12:01:08 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Select (HMO)	01	01		1			H3351	016	0	2023	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	7	1					1	08/03/2022	2023.01	08/03/2022 10:47:57 AM Eastern Daylight Time	08/03/2022 01:45:48 PM Eastern Daylight Time	07/31/2022 12:01:30 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Basic (HMO)	01	01		1			H3351	017	0	2023	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	08/05/2022	2023.01	08/05/2022 12:27:27 PM Eastern Daylight Time	08/03/2022 03:24:30 PM Eastern Daylight Time	07/31/2022 12:01:50 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Advanced (HMO-POS)	01	02		1			H3351	018	0	2023	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	08/03/2022	2023.01	08/03/2022 10:48:48 AM Eastern Daylight Time	08/03/2022 01:46:50 PM Eastern Daylight Time	07/31/2022 12:02:12 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Advanced (HMO-POS)	01	02		1			H3351	019	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 12:40:24 PM Eastern Daylight Time	08/03/2022 01:47:22 PM Eastern Daylight Time	07/31/2022 12:02:32 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Extra (HMO)	01	01		1			H3351	020	0	2023	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	021	0	1	01	01	H3351_021_0	7	1					1	08/05/2022	2023.01	08/05/2022 12:27:16 PM Eastern Daylight Time	08/03/2022 01:47:52 PM Eastern Daylight Time	07/31/2022 12:02:54 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Extra (HMO)	01	01		1			H3351	021	0	2023	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	801	0	1	02	01	H3351_801_0	4	1						05/31/2022	2023.01	05/31/2022 07:30:59 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	Western New York		1	1656	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						05/31/2022	2023.01	05/31/2022 07:31:14 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	Metro Rochester Area and Central New York		1	182691	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	05/31/2022	2023.01	05/31/2022 07:31:23 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	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	05/31/2022	2023.01	05/31/2022 07:31:37 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	Metro Rochester Area and Central New York		1	1629	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						05/30/2022	2023.01	05/30/2022 08:53:34 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	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						05/30/2022	2023.01	05/30/2022 11:01:07 AM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	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	10	1			2		1	08/05/2022	2023.01	08/05/2022 12:30:43 PM Eastern Daylight Time	08/04/2022 08:41:14 PM Eastern Daylight Time	08/04/2022 05:33:32 PM Eastern Daylight Time			08/05/2022 02:23:46 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	2023	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	9	1			1		0	07/06/2022	2023.01	07/06/2022 04:30:43 PM Eastern Daylight Time	08/04/2022 08:42:02 PM Eastern Daylight Time	08/04/2022 05:34:34 PM Eastern Daylight Time			08/05/2022 02:28:46 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	2023	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	9	1	2	1	1		0	07/08/2022	2023.01	07/08/2022 08:57:55 AM Eastern Daylight Time	08/04/2022 08:43:02 PM Eastern Daylight Time	08/04/2022 05:35:24 PM Eastern Daylight Time			08/05/2022 02:33:52 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	2023	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	034	0	1	01	01	H3359_034_0	10	1	2	1	2		0	08/05/2022	2023.01	08/05/2022 12:28:20 PM Eastern Daylight Time	08/04/2022 08:44:14 PM Eastern Daylight Time	08/04/2022 05:36:18 PM Eastern Daylight Time			08/05/2022 02:38:36 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	2023	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		(866)585-9280		(866)585-9280		(888)260-1010		(888)260-1010		(866)585-9280		(866)585-9280		(888)542-3821		(888)542-3821		(877)662-4886		(877)662-4886		(888)542-3821		(888)542-3821		(877)662-4886		(877)662-4886		2					2					2	2			
H3359	038	0	1	01	01	H3359_038_0	10	1	2	1	1		0	06/06/2022	2023.01	06/06/2022 05:49:08 PM Eastern Daylight Time	08/04/2022 08:45:30 PM Eastern Daylight Time	08/04/2022 05:36:48 PM Eastern Daylight Time			08/05/2022 02:43:44 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	2023	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						05/26/2022	2023.01	05/26/2022 09:58:51 AM Eastern Daylight Time					05/26/2022 05:00:56 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	2023	United States		1	120	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	809	0	1	01	01	H3359_809_0	1	1				0	0	05/26/2022	2023.01	05/26/2022 07:33:19 AM Eastern Daylight Time					05/26/2022 05:00:56 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	2023	United States		1	120	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			
H3362	016	0	1	01	01	H3362_016_0	4	1				0	0	07/12/2022	2023.01	07/12/2022 04:28:01 PM Eastern Daylight Time	06/04/2022 05:48:26 PM Eastern Daylight Time				07/15/2022 08:31:15 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Encompass 65 (HMO)	01	01		1			H3362	016	0	2023	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	5	1					1	08/03/2022	2023.01	08/03/2022 09:19:21 AM Eastern Daylight Time	08/03/2022 12:22:44 PM Eastern Daylight Time	08/03/2022 11:25:32 AM Eastern Daylight Time			08/05/2022 09:33:16 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Encompass 65 Basic (HMO)	01	01		1			H3362	017	0	2023	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	5	1		1			0	08/03/2022	2023.01	08/03/2022 09:26:12 AM Eastern Daylight Time	08/03/2022 12:25:38 PM Eastern Daylight Time	08/03/2022 11:27:24 AM Eastern Daylight Time			08/05/2022 09:33:16 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare Family Choice (HMO I-SNP)	01	01		1			H3362	020	0	2023	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	5	1					1	08/03/2022	2023.01	08/03/2022 09:27:55 AM Eastern Daylight Time	08/03/2022 12:28:30 PM Eastern Daylight Time	08/03/2022 11:29:18 AM Eastern Daylight Time			08/05/2022 09:33:16 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	2023	Western New York		2		2			2									independenthealth.com	independenthealth.com	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	5	1					1	08/03/2022	2023.01	08/03/2022 09:36:37 AM Eastern Daylight Time	08/03/2022 12:31:24 PM Eastern Daylight Time	08/03/2022 11:31:42 AM Eastern Daylight Time			08/05/2022 09:33:16 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	2023	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	039	0	1	01	01	H3362_039_0	5	1					1	08/05/2022	2023.01	08/05/2022 09:24:14 AM Eastern Daylight Time	08/03/2022 12:34:18 PM Eastern Daylight Time	08/03/2022 11:34:18 AM Eastern Daylight Time			08/05/2022 09:33:16 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Encompass 65 Edge (HMO)	01	01		1			H3362	039	0	2023	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	6	1		1			1	08/03/2022	2023.01	08/03/2022 09:40:58 AM Eastern Daylight Time	08/03/2022 12:37:00 PM Eastern Daylight Time	08/03/2022 11:36:58 AM Eastern Daylight Time			08/05/2022 09:33:16 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Assure Advantage (HMO C-SNP)	01	01		1			H3362	040	0	2023	Erie County		2		2			1	4			00001000000000000000000					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	01	01	H3362_801_0	2	1						06/01/2022	2023.01	06/01/2022 11:54:41 AM Eastern Daylight Time					06/06/2022 09:33:31 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare Encompass (HMO)	01	01		1			H3362	801	0	2023	New York State		1	66653	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	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;16b;	2		1					2				
H3362	807	0	1	02	01	H3362_807_0	2	1						06/01/2022	2023.01	06/01/2022 11:56:27 AM Eastern Daylight Time					06/06/2022 09:33:31 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare Encompass (HMO-POS)	01	02		1			H3362	807	0	2023	IH Network and Medicare Deemed Network		1	18924	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	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;16b;	2		1	2		2		1				
H3362	819	0	1	02	01	H3362_819_0	2	1				0	0	06/01/2022	2023.01	06/01/2022 11:58:09 AM Eastern Daylight Time					06/06/2022 09:33:31 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare Encompass (HMO-POS)	01	02		1			H3362	819	0	2023	IH Network and Medicare Deemed Network		1	3540	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	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;16b;	2		1	2		2		1				
H3362	820	0	1	01	01	H3362_820_0	2	1				0	0	06/01/2022	2023.01	06/01/2022 11:59:22 AM Eastern Daylight Time					06/06/2022 09:33:31 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Medicare Encompass (HMO)	01	01		1			H3362	820	0	2023	New York State		1	61405	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	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;16b;	2		1					1				
H3379	001	0	1	02	01	H3379_001_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:24:08 PM Central Daylight Time	08/03/2022 12:16:20 PM Central Daylight Time	07/31/2022 02:11:17 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H3379	001	0	2023	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	08/15/2022	2023.01	08/15/2022 11:09:37 AM Central Daylight Time	08/03/2022 12:17:07 PM Central Daylight Time	07/31/2022 02:11:42 AM Central Daylight Time			08/15/2022 04:34:51 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	2023	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	08/15/2022	2023.01	08/15/2022 11:09:46 AM Central Daylight Time	08/03/2022 12:17:54 PM Central Daylight Time	07/31/2022 02:12:07 AM Central Daylight Time			08/15/2022 04:34:51 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	2023	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	02	01	H3379_039_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:24:38 PM Central Daylight Time	08/03/2022 12:18:42 PM Central Daylight Time	07/31/2022 02:12:31 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H3379	039	0	2023	Select Counties in New York		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(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	02	01	H3379_040_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:25:20 PM Central Daylight Time	08/03/2022 12:19:26 PM Central Daylight Time	07/31/2022 02:12:56 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H3379	040	0	2023	Select Counties in New York		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(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	02	01	H3379_041_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:25:50 PM Central Daylight Time	08/03/2022 12:20:11 PM Central Daylight Time	07/31/2022 02:13:20 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H3379	041	0	2023	Select Counties in New York		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(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	043	0	1	02	01	H3379_043_0	3	1					1	08/04/2022	2023.01	08/04/2022 02:26:18 PM Central Daylight Time	08/03/2022 12:21:00 PM Central Daylight Time	07/31/2022 02:13:45 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value Care (HMO-POS)	01	02		1			H3379	043	0	2023	Nassau 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			
H3379	045	0	1	02	01	H3379_045_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:26:40 PM Central Daylight Time	08/03/2022 12:21:47 PM Central Daylight Time	07/31/2022 02:14:09 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H3379	045	0	2023	Select Counties in New York		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(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	046	0	1	02	01	H3379_046_0	3	1					1	08/04/2022	2023.01	08/04/2022 02:27:31 PM Central Daylight Time	08/03/2022 12:22:33 PM Central Daylight Time	07/31/2022 02:14:33 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H3379	046	0	2023	Broome, Chenango, and Delaware 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			
H3384	013	0	1	01	01	H3384_013_0	7	1					1	08/03/2022	2023.01	08/03/2022 11:49:29 AM Eastern Daylight Time	08/04/2022 12:34:14 PM Eastern Daylight Time	08/04/2022 12:34:33 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Shield Senior Blue 652 (HMO)	01	01		1			H3384	013	0	2023	Northeastern New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	019	0	1	01	01	H3384_019_0	7	1					1	07/18/2022	2023.01	07/18/2022 03:07:58 PM Eastern Daylight Time	08/04/2022 12:34:15 PM Eastern Daylight Time	08/04/2022 12:34:33 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Cross Blue Shield Senior Blue 651 (HMO)	01	01		1			H3384	019	0	2023	Western New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	022	0	1	01	01	H3384_022_0	4	1				0	0	07/18/2022	2023.01	07/18/2022 03:08:08 PM Eastern Daylight Time	06/05/2022 11:21:24 PM Eastern Daylight Time				07/18/2022 03:11:59 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Cross Blue Shield Senior Blue 601 (HMO)	01	01		1			H3384	022	0	2023	Western New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3384	058	0	1	01	01	H3384_058_0	7	1					1	07/18/2022	2023.01	07/18/2022 03:08:24 PM Eastern Daylight Time	08/04/2022 12:34:15 PM Eastern Daylight Time	08/04/2022 12:34:33 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Cross Blue Shield Senior Blue Select (HMO)	01	01		1			H3384	058	0	2023	Western New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	059	0	1	01	01	H3384_059_0	8	1					1	07/18/2022	2023.01	07/18/2022 03:08:36 PM Eastern Daylight Time	08/04/2022 12:34:15 PM Eastern Daylight Time	08/04/2022 12:34:33 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Shield Freedom Plus (HMO)	01	01		1			H3384	059	0	2023	Northeastern New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	062	0	1	01	01	H3384_062_0	7	1					1	07/18/2022	2023.01	07/18/2022 03:08:47 PM Eastern Daylight Time	08/04/2022 12:34:15 PM Eastern Daylight Time	08/04/2022 12:34:33 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Cross Blue Shield BlueSaver (HMO)	01	01		1			H3384	062	0	2023	Western New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	063	0	1	01	01	H3384_063_0	7	1					1	07/18/2022	2023.01	07/18/2022 03:08:57 PM Eastern Daylight Time	08/04/2022 12:34:15 PM Eastern Daylight Time	08/04/2022 12:34:34 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Shield Freedom Value (HMO)	01	01		1			H3384	063	0	2023	Northeastern New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	067	0	1	01	01	H3384_067_0	7	1						07/18/2022	2023.01	07/18/2022 03:09:06 PM Eastern Daylight Time	08/04/2022 12:34:15 PM Eastern Daylight Time	08/04/2022 12:34:34 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Cross Blue Shield Senior Blue Basic (HMO)	01	01		1			H3384	067	0	2023	Western New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	805	0	1	01	01	H3384_805_0	2	1				0	0	06/03/2022	2023.01	06/03/2022 01:33:13 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	HMO Group MA Only Plan (HMO)	01	01		1			H3384	805	0	2023	Western and Northeastern New York		1	0	2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.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;9a1;9b;10a;11a;11b;11c;14a;15;	2		1					2				
H3384	806	0	1	01	01	H3384_806_0	2	1						06/03/2022	2023.01	06/03/2022 01:34:51 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	HMO Group (MA-PD) Calendar Year (HMO)	01	01		1			H3384	806	0	2023	Western and Northeastern New York		1	52063	2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.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;9a1;9b;10a;11a;11b;11c;14a;15;	2		1					2				
H3384	811	0	1	02	01	H3384_811_0	2	1						06/03/2022	2023.01	06/03/2022 01:42:03 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	HMOPOS Group (MA-PD) Calendar Year (HMO-POS)	01	02		1			H3384	811	0	2023	Western and Northeastern New York		1	0	2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.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;9a1;9b;10a;11a;11b;11c;14a;15;	2		1	2		2		2				
H3384	812	0	1	02	01	H3384_812_0	2	1				0	0	06/03/2022	2023.01	06/03/2022 01:43:47 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	HMOPOS Group MA Only Calendar Year (HMO-POS)	01	02		1			H3384	812	0	2023	Western and Northeastern New York		1	0	2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.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;9a1;9b;10a;11a;11b;11c;14a;15;	2		1	2		2		2				
H3384	813	0	1	01	01	H3384_813_0	3	1						06/03/2022	2023.01	06/03/2022 01:46:36 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	HMO Group  (MA-PD) ASO Calendar Year (HMO)	01	01		1			H3384	813	0	2023	Western and Northeastern New York		1	0	2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.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;9a1;9b;10a;11a;11b;11c;14a;15;	2		1					2				
H3387	013	0	1	01	01	H3387_013_0	2	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 01:10:07 PM Central Daylight Time	08/03/2022 10:34:31 AM Central Daylight Time	07/31/2022 02:14:58 AM Central Daylight Time			08/04/2022 05:04:18 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	2023	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	02	01	H3387_014_1	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 02:29:11 PM Central Daylight Time	08/03/2022 10:35:16 AM Central Daylight Time	07/31/2022 02:15:23 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)	01	02		1			H3387	014	1	2023	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	014	2	1	02	01	H3387_014_2	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 02:29:22 PM Central Daylight Time	08/03/2022 10:36:01 AM Central Daylight Time	07/31/2022 02:15:48 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)	01	02		1			H3387	014	2	2023	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			
H3387	015	1	1	02	01	H3387_015_1	2	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 01:15:00 PM Central Daylight Time	08/03/2022 10:36:45 AM Central Daylight Time	07/31/2022 02:16:13 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)	01	02		1			H3387	015	1	2023	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	02	01	H3387_015_2	2	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 01:16:03 PM Central Daylight Time	08/03/2022 10:37:31 AM Central Daylight Time	07/31/2022 02:16:38 AM Central Daylight Time			08/04/2022 05:04:18 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)	01	02		1			H3387	015	2	2023	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	12	1			1	0	0	07/18/2022	2023.01	07/18/2022 04:29:37 PM Eastern Daylight Time	06/06/2022 11:51:59 AM Eastern Daylight Time				07/18/2022 04:36:17 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	2023	Greater Capital Region of New York State		2		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	11	8a1;8a2;	18a1;
H3388	002	0	1	01	01	H3388_002_0	13	1			1		1	08/05/2022	2023.01	08/05/2022 01:25:09 PM Eastern Daylight Time	08/05/2022 01:43:54 PM Eastern Daylight Time	08/05/2022 01:43:54 PM Eastern Daylight Time			08/05/2022 01:47:06 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	2023	Greater Capital Region of New York State		2		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	11	8a1;8a2;	18a1;
H3388	004	0	1	01	01	H3388_004_0	13	1			1		1	07/18/2022	2023.01	07/18/2022 04:34:14 PM Eastern Daylight Time	08/05/2022 01:43:54 PM Eastern Daylight Time	08/05/2022 01:43:54 PM Eastern Daylight Time			08/05/2022 01:47:06 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	2023	Greater Capital Region of New York State		2		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	11	8a1;8a2;	18a1;
H3388	013	0	1	01	01	H3388_013_0	12	1			1		1	08/05/2022	2023.01	08/05/2022 10:41:31 AM Eastern Daylight Time	08/05/2022 01:43:55 PM Eastern Daylight Time	08/05/2022 01:43:55 PM Eastern Daylight Time			08/05/2022 01:47:06 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	2023	Greater Capital Region of New York State		2		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	11	8a1;8a2;	18a1;
H3388	014	0	1	01	01	H3388_014_0	12	1			1		1	08/05/2022	2023.01	08/05/2022 10:54:34 AM Eastern Daylight Time	08/05/2022 01:43:55 PM Eastern Daylight Time	08/05/2022 01:43:55 PM Eastern Daylight Time			08/05/2022 01:47:06 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	2023	Greater Capital Region of New York State		2		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	11	8a1;8a2;	18a1;
H3388	018	0	1	01	01	H3388_018_0	10	1		1	2		1	08/10/2022	2023.01	08/10/2022 03:24:21 PM Eastern Daylight Time	08/05/2022 01:43:56 PM Eastern Daylight Time	08/05/2022 01:43:56 PM Eastern Daylight Time			08/10/2022 03:27:58 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Care Advantage (HMO C-SNP)	01	01		1			H3388	018	0	2023	Greater Capital Region of New York State		2		2			1	4			00000000000000000010000					https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(800)364-3680		(518)641-5400		(800)364-3680		(518)641-5400		(800)364-3680		(518)641-5400		(800)364-3680		(518)641-5400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	8a1;8a2;	18a1;
H3388	019	0	1	01	01	H3388_019_0	12	1	2	1	2		0	08/03/2022	2023.01	08/03/2022 12:03:25 PM Eastern Daylight Time	08/05/2022 01:43:56 PM Eastern Daylight Time	08/05/2022 01:43:56 PM Eastern Daylight Time			08/05/2022 01:47:06 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Dual Advantage (HMO D-SNP)	01	01		1			H3388	019	0	2023	Greater Capital Region of New York State		2		2			1	3		2					1	https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(800)364-3680		(518)641-5400		(800)364-3680		(518)641-5400		(800)364-3680		(518)641-5400		(800)364-3680		(518)641-5400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3388	801	0	1	01	01	H3388_801_0	7	1						05/11/2022	2023.01	05/11/2022 11:17:38 AM Eastern Daylight Time					06/06/2022 11:57:34 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	2023	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	7	1						05/11/2022	2023.01	05/11/2022 10:43:39 AM Eastern Daylight Time					06/06/2022 11:57:34 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	2023	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	7	1				0	0	05/11/2022	2023.01	05/11/2022 11:18:06 AM Eastern Daylight Time					06/06/2022 11:57:34 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	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 11:15:32 AM Central Daylight Time	08/05/2022 10:39:03 AM Eastern Daylight Time	08/05/2022 10:39:03 AM Eastern Daylight Time			08/05/2022 12:37:34 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	2023	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		(866)760-0823		(866)760-0823		(877)494-7647		(877)494-7647		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3404	003	2	1	04	01	H3404_003_2	7	1					1	08/04/2022	2023.01	08/04/2022 11:16:05 AM Central Daylight Time	08/05/2022 10:39:24 AM Eastern Daylight Time	08/05/2022 10:39:24 AM Eastern Daylight Time			08/05/2022 12:37:34 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	2023	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		(866)760-0823		(866)760-0823		(877)494-7647		(877)494-7647		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3404	004	0	1	04	01	H3404_004_0	6	1				0	0	06/28/2022	2023.01	06/28/2022 10:41:01 AM Central Daylight Time	06/06/2022 11:00:33 AM Eastern Daylight Time				07/12/2022 08:15:46 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Freedom+ (PPO)	01	04		1			H3404	004	0	2023	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		(866)760-0823		(866)760-0823										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3404	801	0	1	04	01	H3404_801_0	3	1				0	0	05/27/2022	2023.01	05/27/2022 01:46:35 PM Eastern Daylight Time					06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO EGWP Medical Only (PPO)	01	04		1			H3404	801	0	2023	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		(866)760-0823		(866)760-0823										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;7e;7h;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;	2		1									
H3404	810	0	1	04	01	H3404_810_0	3	1						05/26/2022	2023.01	05/26/2022 10:38:33 AM Central Daylight Time					06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO EGWP Complete (PPO)	01	04		1			H3404	810	0	2023	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		(866)760-0823		(866)760-0823		(877)494-7647		(877)494-7647		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7e;7h;8b1;8b2;9b;10a;11a;11b;11c;15;	2		1									
H3404	811	0	1	04	01	H3404_811_0	3	1						05/27/2022	2023.01	05/27/2022 01:45:36 PM Eastern Daylight Time					06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO EGWP Classic (PPO)	01	04		1			H3404	811	0	2023	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	(877)494-7647		(877)494-7647		(877)494-7647		(877)494-7647		(877)494-7647		(877)494-7647		(877)494-7647		(877)494-7647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7e;7h;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;	2		1									
H3407	001	0	1	01	01	H3407_001_0	7	1	2	1			0	07/28/2022	2023.01	07/28/2022 09:52:19 AM Mountain Daylight Time	08/01/2022 01:27:02 PM Mountain Daylight Time	08/01/2022 12:39:36 PM Mountain Daylight Time			08/02/2022 06:23:49 PM 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	2023	El Paso and Hudspeth counties		2		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	9	1					1	08/10/2022	2023.01	08/10/2022 01:56:43 PM Central Daylight Time	08/05/2022 09:17:05 AM Central Daylight Time	08/11/2022 04:10:31 PM Central Daylight Time			08/11/2022 04:24:20 PM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Align (PPO)	01	04		1			H3416	001	6	2023	Central Iowa & Western Illinois	Cedar Rapids, Central IA, and Certain IL Counties	2		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	9	1					1	08/10/2022	2023.01	08/10/2022 01:57:30 PM Central Daylight Time	08/05/2022 09:17:06 AM Central Daylight Time	08/11/2022 04:10:35 PM Central Daylight Time			08/11/2022 04:24:20 PM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Align (PPO)	01	04		1			H3416	001	7	2023	Central Iowa & Western Illinois	Fort Dodge, Quad Cities, Waterloo, Sioux City	2		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	9	1					1	08/10/2022	2023.01	08/10/2022 01:58:30 PM Central Daylight Time	08/05/2022 09:17:06 AM Central Daylight Time	08/11/2022 04:10:39 PM Central Daylight Time			08/11/2022 04:24:20 PM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Symmetry (PPO)	01	04		1			H3416	002	4	2023	Central Iowa & Western Illinois	Cedar Rapids, Central IA, and Certain IL Counties	2		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	9	1					1	08/10/2022	2023.01	08/10/2022 01:59:12 PM Central Daylight Time	08/05/2022 09:17:06 AM Central Daylight Time	08/11/2022 04:10:43 PM Central Daylight Time			08/11/2022 04:24:20 PM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Symmetry (PPO)	01	04		1			H3416	002	5	2023	Central Iowa & Western Illinois	Fort Dodge, Quad Cities, Waterloo, and Sioux City	2		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						06/01/2022	2023.01	06/01/2022 11:29:00 AM Central Daylight Time					06/03/2022 10:53:09 PM 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	2023	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	06/01/2022	2023.01	06/01/2022 11:28:26 AM Central Daylight Time					06/03/2022 10:53:09 PM 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	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 02:29:53 PM Central Daylight Time	08/03/2022 12:02:11 PM Central Daylight Time	07/31/2022 02:17:02 AM Central Daylight Time			08/04/2022 05:16:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Mosaic Choice (PPO)	01	04		1			H3418	001	0	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 02:30:52 PM Central Daylight Time	08/03/2022 12:02:55 PM Central Daylight Time	07/31/2022 02:17:26 AM Central Daylight Time			08/04/2022 05:16:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value Care (PPO)	01	04		1			H3418	002	0	2023	Select Counties in New York		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)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;	
H3418	003	0	1	04	01	H3418_003_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:31:27 PM Central Daylight Time	08/03/2022 12:03:37 PM Central Daylight Time	07/31/2022 02:17:51 AM Central Daylight Time			08/04/2022 05:16:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Premier Choice (PPO)	01	04		1			H3418	003	0	2023	Nassau County		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			
H3418	004	0	1	04	01	H3418_004_0	3	1					1	08/04/2022	2023.01	08/04/2022 02:31:52 PM Central Daylight Time	08/03/2022 12:04:21 PM Central Daylight Time	07/31/2022 02:18:16 AM Central Daylight Time			08/04/2022 05:16:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H3418	004	0	2023	Select Counties in New York		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			
H3418	005	0	1	04	01	H3418_005_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:32:22 PM Central Daylight Time	08/03/2022 12:05:03 PM Central Daylight Time	07/31/2022 02:18:40 AM Central Daylight Time			08/04/2022 05:16:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H3418	005	0	2023	Select Counties in New York		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			
H3418	006	0	1	04	01	H3418_006_0	3	1					1	08/04/2022	2023.01	08/04/2022 02:33:44 PM Central Daylight Time	08/03/2022 12:05:46 PM Central Daylight Time	07/31/2022 02:19:05 AM Central Daylight Time			08/04/2022 05:16:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H3418	006	0	2023	Select Counties in New York		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			
H3418	007	0	1	04	01	H3418_007_0	3	1					1	08/04/2022	2023.01	08/04/2022 02:34:09 PM Central Daylight Time	08/03/2022 12:06:28 PM Central Daylight Time	07/31/2022 02:19:29 AM Central Daylight Time			08/04/2022 05:16:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H3418	007	0	2023	Select Counties in New York		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			
H3418	008	0	1	04	01	H3418_008_0	3	1					1	08/04/2022	2023.01	08/04/2022 02:35:07 PM Central Daylight Time	08/03/2022 12:07:12 PM Central Daylight Time	07/31/2022 02:19:53 AM Central Daylight Time			08/04/2022 05:16:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H3418	008	0	2023	Select Counties in New York		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			
H3419	001	0	1	01	01	H3419_001_0	7	1		1			0	08/11/2022	2023.01	08/11/2022 01:00:29 PM Eastern Daylight Time	08/05/2022 09:51:16 AM Eastern Daylight Time	08/05/2022 07:19:45 AM Eastern Daylight Time			08/11/2022 05:24:47 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	2023	Colorado (partial)		2		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	6	1		1			1	08/11/2022	2023.01	08/11/2022 01:01:13 PM Eastern Daylight Time	08/05/2022 09:51:43 AM Eastern Daylight Time	08/05/2022 07:20:08 AM Eastern Daylight Time			08/11/2022 05:24:47 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	2023	Colorado (partial)		2		2			1	4			00000000000000000010000					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	003	0	1	01	01	H3419_003_0	4	1					0	08/04/2022	2023.01	08/04/2022 09:46:28 PM Eastern Daylight Time	08/05/2022 07:52:10 AM Mountain Daylight Time	08/05/2022 05:20:33 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	PERENNIAL ADVANTAGE OF COLORADO, INC.	Perennial Advantage	www.perennialadvantage.com	Perennial Advantage (HMO)	01	01		1			H3419	003	0	2023	Colorado (partial)		2		2			2									www.placeholder.com	www.placeholder.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						05/23/2022	2023.01	05/23/2022 06:21:11 PM Eastern Daylight Time		05/23/2022 06:15:10 PM Eastern Daylight Time			05/23/2022 06:28:02 PM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	www.suncoastpace.org	Suncoast PACE, Inc. (PACE)	08	20		1			H3430	001	0	2023	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						05/23/2022	2023.01	05/23/2022 06:21:35 PM Eastern Daylight Time		05/23/2022 06:15:13 PM Eastern Daylight Time			05/23/2022 06:28:02 PM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	www.suncoastpace.org	Suncoast PACE, Inc. (PACE)	08	20		1			H3430	002	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:36:28 AM Central Daylight Time	08/03/2022 10:38:16 AM Central Daylight Time	07/31/2022 02:20:18 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H3442	001	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:39:02 AM Central Daylight Time	08/03/2022 10:39:01 AM Central Daylight Time	07/31/2022 02:20:42 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H3442	003	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:40:48 AM Central Daylight Time	08/03/2022 10:39:45 AM Central Daylight Time	07/31/2022 02:21:07 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H3442	004	0	2023	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	1	1				0	0	05/30/2022	2023.01	05/30/2022 04:53:51 PM Central Daylight Time	06/01/2022 11:45:04 AM Central Daylight Time				06/02/2022 02:17:17 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H3442	005	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:41:33 AM Central Daylight Time	08/03/2022 10:40:32 AM Central Daylight Time	07/31/2022 02:21:31 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H3442	006	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:41:49 AM Central Daylight Time	08/03/2022 10:41:16 AM Central Daylight Time	07/31/2022 02:21:56 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H3442	007	0	2023	State of 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	1	1				0	0	06/01/2022	2023.01	06/01/2022 02:38:05 PM Central Daylight Time	06/01/2022 11:47:00 AM Central Daylight Time				06/02/2022 02:17:17 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H3442	008	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:42:22 AM Central Daylight Time	08/03/2022 10:42:01 AM Central Daylight Time	07/31/2022 02:22:21 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H3442	010	0	2023	State of 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			
H3442	011	0	1	04	01	H3442_011_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:42:46 AM Central Daylight Time	08/03/2022 10:42:45 AM Central Daylight Time	07/31/2022 02:22:45 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Flex (PPO)	01	04		1			H3442	011	0	2023	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			
H3443	001	0	1	01	01	H3443_001_0	5	1			1		0	08/05/2022	2023.01	08/05/2022 02:21:02 PM Pacific Daylight Time	08/05/2022 02:17:53 PM Pacific Daylight Time	08/02/2022 10:50:02 AM Pacific Daylight Time			08/05/2022 03:03:37 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health the ONE (HMO)	01	01		1			H3443	001	0	2023	Maricopa		2		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			
H3443	002	0	1	01	01	H3443_002_0	5	1			1		0	08/05/2022	2023.01	08/05/2022 02:21:14 PM Pacific Daylight Time	08/05/2022 02:17:45 PM Pacific Daylight Time	08/02/2022 10:51:12 AM Pacific Daylight Time			08/05/2022 03:03:37 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health the ONE (HMO)	01	01		1			H3443	002	0	2023	Pima, Santa Cruz Counties		2		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			
H3443	003	0	1	01	01	H3443_003_0	6	1		1	2		1	08/05/2022	2023.01	08/05/2022 02:21:32 PM Pacific Daylight Time	08/05/2022 02:17:48 PM Pacific Daylight Time	08/02/2022 02:21:52 PM Pacific Daylight Time			08/05/2022 03:03:37 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Heart & Diabetes (HMO C-SNP)	01	01		1			H3443	003	0	2023	Maricopa, Pima, Santa Cruz Counties		2		2			1	4			00000000000000000010000					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			
H3443	801	0	1	01	01	H3443_801_0	2	1						06/03/2022	2023.01	06/03/2022 12:15:05 PM Pacific Daylight Time					06/06/2022 05:39:53 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	801	0	2023	Maricopa, Pima, Santa Cruz Counties		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			
H3443	802	0	1	01	01	H3443_802_0	2	1						06/03/2022	2023.01	06/03/2022 12:15:48 PM Pacific Daylight Time					06/06/2022 05:39:53 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	802	0	2023	Maricopa, Pima, Santa Cruz Counties		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			
H3443	803	0	1	01	01	H3443_803_0	2	1				0	0	06/03/2022	2023.01	06/03/2022 12:16:43 PM Pacific Daylight Time					06/06/2022 05:39:53 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	2023	Maricopa, Pima, Santa Cruz Counties		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			
H3443	804	0	1	01	01	H3443_804_0	2	1				0	0	06/03/2022	2023.01	06/03/2022 12:17:44 PM Pacific Daylight Time					06/06/2022 05:39:53 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	804	0	2023	Maricopa, Pima, Santa Cruz Counties		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			
H3447	001	0	1	01	01	H3447_001_0	5	1			2		0	08/01/2022	2023.01	08/01/2022 05:09:04 PM Eastern Daylight Time	08/04/2022 06:23:07 PM Eastern Daylight Time	08/04/2022 06:42:08 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Local (HMO)	01	01		1			H3447	001	0	2023	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	08/01/2022	2023.01	08/01/2022 05:09:17 PM Eastern Daylight Time	08/04/2022 06:23:08 PM Eastern Daylight Time	08/04/2022 06:42:10 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	Richmond Metropolitan, West & So. of Richmond Area		2		2			1	4			00000000000100000000000					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	07/12/2022	2023.01	07/12/2022 10:29:09 AM Eastern Daylight Time	08/04/2022 06:23:09 PM Eastern Daylight Time	08/04/2022 06:42:13 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	Richmond Metropolitan, West & So. of Richmond Area		2		2			1	4			00000000000000000010000					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	5	1			2		0	07/12/2022	2023.01	07/12/2022 10:29:23 AM Eastern Daylight Time	08/04/2022 06:23:11 PM Eastern Daylight Time	08/04/2022 06:42:16 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Smart Fit (HMO)	01	01		1			H3447	005	0	2023	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	5	1		1	2		0	07/12/2022	2023.01	07/12/2022 10:29:41 AM Eastern Daylight Time	08/04/2022 06:23:12 PM Eastern Daylight Time	08/04/2022 06:42:18 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	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	7	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 12:26:16 PM Eastern Daylight Time	08/04/2022 06:20:53 PM Eastern Daylight Time	08/04/2022 06:37:56 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 02:19:37 PM Eastern Daylight Time	08/04/2022 06:20:54 PM Eastern Daylight Time	08/04/2022 06:37:59 PM Eastern Daylight Time			08/04/2022 07:09:53 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	013	0	2023	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	5	1			2		1	08/01/2022	2023.01	08/01/2022 12:56:50 PM Eastern Daylight Time	08/04/2022 06:20:56 PM Eastern Daylight Time	08/04/2022 06:38:01 PM Eastern Daylight Time			08/04/2022 07:09:53 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	014	0	2023	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	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:06:12 PM Venezuela Standard Time	08/04/2022 06:17:37 PM Venezuela Standard Time	08/04/2022 06:31:37 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H3447	018	0	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:22:05 AM Eastern Daylight Time	08/04/2022 06:16:38 PM Eastern Daylight Time	08/04/2022 06:29:48 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	024	0	1	01	01	H3447_024_0	5	1			1		0	08/01/2022	2023.01	08/01/2022 04:16:50 PM Eastern Daylight Time	08/04/2022 06:16:40 PM Eastern Daylight Time	08/04/2022 06:29:51 PM Eastern Daylight Time			08/04/2022 09:35:16 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H3447	024	0	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 02:24:59 PM Eastern Daylight Time	08/04/2022 06:20:57 PM Eastern Daylight Time	08/04/2022 06:38:04 PM Eastern Daylight Time			08/04/2022 07:09:53 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Essential (HMO)	01	01		1			H3447	025	0	2023	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	5	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:30:44 PM Pacific Daylight Time	08/04/2022 03:20:00 PM Pacific Daylight Time	08/04/2022 03:36:12 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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	6	1			2		0	08/01/2022	2023.01	08/01/2022 02:26:16 PM Eastern Daylight Time	08/04/2022 06:20:58 PM Eastern Daylight Time	08/04/2022 06:38:07 PM Eastern Daylight Time			08/04/2022 07:09:53 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H3447	027	0	2023	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	08/01/2022	2023.01	08/01/2022 02:27:31 PM Eastern Daylight Time	08/04/2022 06:21:00 PM Eastern Daylight Time	08/04/2022 06:38:09 PM Eastern Daylight Time			08/04/2022 07:09:53 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H3447	028	0	2023	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	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 12:43:04 PM Eastern Daylight Time	08/04/2022 06:21:01 PM Eastern Daylight Time	08/04/2022 06:38:12 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1		1	2		0	08/02/2022	2023.01	08/02/2022 12:46:07 AM Pacific Daylight Time		08/04/2022 03:36:14 PM Pacific Daylight Time		08/04/2022 03:20:01 PM Pacific Daylight Time	08/19/2022 08:29:30 AM 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	2023	Select Counties in VA		2		2			1	4			00000000100000000000000					https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)469-1763		(844)469-1763		(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	037	0	1	01	01	H3447_037_0	5	1		1	2		1	08/01/2022	2023.01	08/01/2022 05:10:47 PM Eastern Daylight Time	08/04/2022 06:23:13 PM Eastern Daylight Time	08/04/2022 06:42:21 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	Select Counties in VA		2		2			1	4			00000000000000000010000					https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)469-1763		(844)469-1763		(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	5	1			2		1	08/01/2022	2023.01	08/01/2022 03:17:16 PM Venezuela Standard Time	08/04/2022 06:17:38 PM Venezuela Standard Time	08/04/2022 06:31:39 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	038	1	2023	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	5	1			2		1	08/01/2022	2023.01	08/01/2022 03:21:10 PM Venezuela Standard Time	08/04/2022 06:17:39 PM Venezuela Standard Time	08/04/2022 06:31:42 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	038	2	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 02:28:52 PM Eastern Daylight Time	08/04/2022 06:21:03 PM Eastern Daylight Time	08/04/2022 06:38:15 PM Eastern Daylight Time			08/04/2022 07:09:53 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue + Kroger (HMO)	01	01		1			H3447	039	0	2023	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	042	1	1	01	01	H3447_042_1	6	1			2		1	08/01/2022	2023.01	08/01/2022 04:19:08 PM Eastern Daylight Time	08/04/2022 06:16:41 PM Eastern Daylight Time	08/04/2022 06:29:53 PM Eastern Daylight Time			08/04/2022 09:35:16 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	042	1	2023	Indiana	NW/Chicago IN	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	042	2	1	01	01	H3447_042_2	6	1			2		1	08/01/2022	2023.01	08/01/2022 04:19:58 PM Eastern Daylight Time	08/04/2022 06:16:43 PM Eastern Daylight Time	08/04/2022 06:29:56 PM Eastern Daylight Time			08/04/2022 09:35:16 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	042	2	2023	Indiana	Ft Wayne IN	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	042	3	1	01	01	H3447_042_3	6	1			2		1	08/01/2022	2023.01	08/01/2022 04:20:56 PM Eastern Daylight Time	08/04/2022 06:16:44 PM Eastern Daylight Time	08/04/2022 06:29:59 PM Eastern Daylight Time			08/04/2022 09:35:16 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	042	3	2023	Indiana	Indy IN	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	042	4	1	01	01	H3447_042_4	6	1			2		1	08/01/2022	2023.01	08/01/2022 04:21:47 PM Eastern Daylight Time	08/04/2022 06:16:45 PM Eastern Daylight Time	08/04/2022 06:30:02 PM Eastern Daylight Time			08/04/2022 09:35:16 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	042	4	2023	Indiana	Rural IN	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	802	0	1	01	01	H3447_802_0	2	1						05/23/2022	2023.01	05/23/2022 11:53:19 AM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue EGWP MAPD (HMO)	01	01		1			H3447	802	0	2023	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		(888)649-5968		(888)649-5968		(833)348-5340		(833)348-5340		(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;10a;11a;11b;11c;15;16b;18a;	2		1					1				
H3447	804	0	1	01	01	H3447_804_0	2	1						05/20/2022	2023.01	05/20/2022 03:18:45 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	804	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	805	0	1	01	01	H3447_805_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:22:24 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	805	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	806	0	2	01	01	H3447_806_0	2	1						05/23/2022	2023.01	05/23/2022 01:24:20 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	806	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	807	0	2	01	01	H3447_807_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:25:30 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	807	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	809	0	1	01	01	H3447_809_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:25:52 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	809	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	811	0	1	01	01	H3447_811_0	2	1						05/20/2022	2023.01	05/20/2022 03:26:15 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	811	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	812	0	1	01	01	H3447_812_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:46:56 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	812	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	813	0	2	01	01	H3447_813_0	2	1						05/20/2022	2023.01	05/20/2022 03:47:28 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	813	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	814	0	2	01	01	H3447_814_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:47:52 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	814	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	816	0	1	01	01	H3447_816_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:48:13 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	816	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	818	0	1	01	01	H3447_818_0	2	1						05/20/2022	2023.01	05/20/2022 03:48:54 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	818	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	819	0	1	01	01	H3447_819_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:49:29 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	819	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	820	0	2	01	01	H3447_820_0	2	1						05/20/2022	2023.01	05/20/2022 03:49:52 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	820	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	821	0	2	01	01	H3447_821_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:50:21 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	821	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	823	0	1	01	01	H3447_823_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:51:01 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	823	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	825	0	2	01	01	H3447_825_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:55:32 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	825	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	826	0	2	01	01	H3447_826_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:55:20 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	826	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3447	827	0	2	01	01	H3447_827_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 03:55:51 PM Pacific Daylight Time					06/03/2022 10:33:20 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	827	0	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3449	012	0	1	02	01	H3449_012_0	6	1				0	0	06/28/2022	2023.01	06/28/2022 10:47:24 AM Central Daylight Time	06/06/2022 11:00:57 AM Eastern Daylight Time				07/12/2022 08:15:46 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Medical Only (HMO-POS)	01	02		1			H3449	012	0	2023	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		(866)760-0823		(866)760-0823										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3449	023	1	1	02	01	H3449_023_1	7	1					1	08/04/2022	2023.01	08/04/2022 11:26:35 AM Central Daylight Time	08/05/2022 10:39:45 AM Eastern Daylight Time	08/05/2022 10:39:44 AM Eastern Daylight Time			08/05/2022 12:37:34 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-POS)	01	02		1			H3449	023	1	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	023	2	1	02	01	H3449_023_2	7	1					1	08/04/2022	2023.01	08/04/2022 11:26:53 AM Central Daylight Time	08/05/2022 10:40:05 AM Eastern Daylight Time	08/05/2022 10:40:05 AM Eastern Daylight Time			08/05/2022 12:37:34 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-POS)	01	02		1			H3449	023	2	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	023	4	1	02	01	H3449_023_4	7	1					1	08/04/2022	2023.01	08/04/2022 11:27:13 AM Central Daylight Time	08/05/2022 10:40:26 AM Eastern Daylight Time	08/05/2022 10:40:26 AM Eastern Daylight Time			08/05/2022 12:37:34 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-POS)	01	02		1			H3449	023	4	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	023	5	1	02	01	H3449_023_5	7	1					1	08/04/2022	2023.01	08/04/2022 11:27:31 AM Central Daylight Time	08/05/2022 10:40:48 AM Eastern Daylight Time	08/05/2022 10:40:48 AM Eastern Daylight Time			08/05/2022 12:37:34 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-POS)	01	02		1			H3449	023	5	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	024	1	1	02	01	H3449_024_1	8	1					1	08/04/2022	2023.01	08/04/2022 11:27:56 AM Central Daylight Time	08/05/2022 10:41:11 AM Eastern Daylight Time	08/05/2022 10:41:11 AM Eastern Daylight Time			08/05/2022 12:37:34 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-POS)	01	02		1			H3449	024	1	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	024	2	1	02	01	H3449_024_2	7	1					1	08/04/2022	2023.01	08/04/2022 11:28:20 AM Central Daylight Time	08/05/2022 10:41:33 AM Eastern Daylight Time	08/05/2022 10:41:33 AM Eastern Daylight Time			08/05/2022 12:37:34 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-POS)	01	02		1			H3449	024	2	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	024	3	1	02	01	H3449_024_3	7	1					1	08/04/2022	2023.01	08/04/2022 11:28:41 AM Central Daylight Time	08/05/2022 10:41:54 AM Eastern Daylight Time	08/05/2022 10:41:54 AM Eastern Daylight Time			08/05/2022 12:37:34 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-POS)	01	02		1			H3449	024	3	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	026	0	1	01	01	H3449_026_0	7	1					1	08/04/2022	2023.01	08/04/2022 11:29:03 AM Central Daylight Time	08/05/2022 10:42:15 AM Eastern Daylight Time	08/05/2022 10:42:15 AM Eastern Daylight Time			08/05/2022 12:37:34 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	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	027	1	1	01	01	H3449_027_1	7	1					1	08/04/2022	2023.01	08/04/2022 11:30:10 AM Central Daylight Time	08/05/2022 10:42:36 AM Eastern Daylight Time	08/05/2022 10:42:36 AM Eastern Daylight Time			08/05/2022 12:37:34 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	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	027	2	1	01	01	H3449_027_2	7	1					1	08/04/2022	2023.01	08/04/2022 11:29:58 AM Central Daylight Time	08/05/2022 10:42:58 AM Eastern Daylight Time	08/05/2022 10:42:58 AM Eastern Daylight Time			08/05/2022 12:37:34 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	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	805	0	1	01	01	H3449_805_0	3	1				0	0	05/27/2022	2023.01	05/27/2022 02:27:36 PM Eastern Daylight Time					06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO EGWP Medical Only (HMO)	01	01		1			H3449	805	0	2023	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		(866)760-0823		(866)760-0823										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;7e;7h;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3449	814	0	1	01	01	H3449_814_0	3	1						05/24/2022	2023.01	05/24/2022 10:18:36 AM Central Daylight Time					06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO EGWP Complete (HMO)	01	01		1			H3449	814	0	2023	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		(866)760-0823		(866)760-0823		(888)310-4110		(888)310-4110		(866)760-0823		(866)760-0823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7e;7h;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3449	815	0	1	01	01	H3449_815_0	3	1						05/24/2022	2023.01	05/24/2022 10:18:53 AM Central Daylight Time					06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO EGWP Classic (HMO)	01	01		1			H3449	815	0	2023	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		(888)310-4110		(888)310-4110		(888)310-4110		(888)310-4110		(888)310-4110		(888)310-4110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7e;7h;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3464	001	0	1	02	01	H3464_001_0	2	1					1	08/03/2022	2023.01	08/03/2022 11:58:39 AM Central Daylight Time	08/03/2022 10:31:00 AM Central Daylight Time	07/31/2022 02:23:10 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H3464	001	0	2023	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	02	01	H3464_002_0	2	1					1	08/03/2022	2023.01	08/03/2022 11:59:13 AM Central Daylight Time	08/03/2022 10:31:44 AM Central Daylight Time	07/31/2022 02:23:34 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H3464	002	0	2023	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	02	01	H3464_007_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 03:47:00 PM Central Daylight Time	06/01/2022 09:58:12 AM Central Daylight Time				06/03/2022 11:07:37 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H3464	007	0	2023	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			
H3464	008	0	1	02	01	H3464_008_0	2	1					1	08/03/2022	2023.01	08/03/2022 12:00:01 PM Central Daylight Time	08/03/2022 10:32:28 AM Central Daylight Time	07/31/2022 02:23:58 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H3464	008	0	2023	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			
H3467	001	0	1	02	01	H3467_001_0	6	1		1				06/06/2022	2023.01	06/06/2022 10:16:24 AM Central Daylight Time	08/03/2022 11:39:15 AM Central Daylight Time	08/02/2022 12:34:00 PM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	PROCARE ADVANTAGE, LLC	ProCare Advantage	www.procareadvantageplan.com	ProCare Advantage (HMO-POS I-SNP)	01	02		1			H3467	001	0	2023	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	6	1					1	08/04/2022	2023.01	08/04/2022 12:17:04 PM Central Daylight Time	08/04/2022 09:14:26 AM Central Daylight Time	08/03/2022 03:11:06 PM Central Daylight Time			08/05/2022 12:01:36 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	2023	Okanogan, Chelan, Douglas, Grant		2		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	6	1					1	08/04/2022	2023.01	08/04/2022 12:18:31 PM Central Daylight Time	08/04/2022 09:14:55 AM Central Daylight Time	08/03/2022 03:11:31 PM Central Daylight Time			08/05/2022 12:01:36 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	2023	Okanogan, Chelan, Douglas, Grant County		2		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	6	1				0	0	07/12/2022	2023.01	07/12/2022 10:02:26 AM Central Daylight Time	07/24/2022 02:25:56 PM Central Daylight Time				07/28/2022 09:17:55 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	2023	Okanogan, Chelan, Douglas, Grant County		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:19:04 PM Central Daylight Time	08/05/2022 11:52:26 AM Central Daylight Time	08/03/2022 03:11:54 PM Central Daylight Time			08/05/2022 12:01:36 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	2023	Yakima County		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 12:19:30 PM Central Daylight Time	08/05/2022 11:52:53 AM Central Daylight Time	08/03/2022 03:12:16 PM Central Daylight Time			08/05/2022 12:01:36 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	2023	Yakima County		2		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	5	1				0	0	07/12/2022	2023.01	07/12/2022 10:39:33 AM Central Daylight Time	07/24/2022 02:35:47 PM Central Daylight Time				07/28/2022 09:17:55 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	2023	Yakima County		2		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	6	1					1	08/04/2022	2023.01	08/04/2022 12:20:00 PM Central Daylight Time	08/04/2022 09:30:21 AM Central Daylight Time	08/03/2022 03:12:38 PM Central Daylight Time			08/05/2022 12:01:36 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	2023	Okanogan, Chelan, Douglas, Grant County		2		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	8	1					1	08/04/2022	2023.01	08/04/2022 12:21:48 PM Central Daylight Time	08/05/2022 12:34:13 PM Central Daylight Time	08/03/2022 03:12:59 PM Central Daylight Time			08/05/2022 12:57:40 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	2023	Yakima County		2		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	7	1					1	08/04/2022	2023.01	08/04/2022 12:22:15 PM Central Daylight Time	08/04/2022 10:11:26 AM Central Daylight Time	08/03/2022 03:13:20 PM Central Daylight Time			08/05/2022 12:01:36 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	2023	Yakima County		2		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	6	1					1	08/04/2022	2023.01	08/04/2022 10:29:36 AM Central Daylight Time	08/04/2022 09:30:52 AM Central Daylight Time	08/03/2022 03:13:43 PM Central Daylight Time			08/05/2022 12:01:36 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	2023	Okanogan, Chelan, Douglas, Grant		2		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	9	1					1	08/04/2022	2023.01	08/04/2022 01:14:19 PM Central Daylight Time	08/04/2022 09:35:14 AM Central Daylight Time	08/03/2022 03:14:07 PM Central Daylight Time			08/05/2022 12:01:36 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	2023	Okanogan, Chelan, Douglas, Grant		2		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	02	01	H3471_019_0	7	1					1	08/04/2022	2023.01	08/04/2022 12:23:37 PM Central Daylight Time	08/04/2022 10:11:54 AM Central Daylight Time	08/03/2022 03:14:29 PM Central Daylight Time			08/05/2022 12:01:36 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage POS Basic Rx (HMO-POS)	01	02		1			H3471	019	0	2023	Yakima County		2		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	1	1				0	0	04/27/2022	2023.01	04/27/2022 09:15:29 AM Central Daylight Time					05/31/2022 03:20:25 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H3471	801	0	2023	Central Washington		1	23	1	1		2									www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	1	2;	1					1				
H3471	802	0	1	01	01	H3471_802_0	1	1						04/27/2022	2023.01	04/27/2022 09:15:12 AM Central Daylight Time					05/31/2022 03:20:25 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H3471	802	0	2023	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;9b;10a;11a;11b;15;	1	2;	1					1				
H3471	803	0	1	01	01	H3471_803_0	1	1						04/27/2022	2023.01	04/27/2022 09:14:49 AM Central Daylight Time					05/31/2022 03:20:25 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO Rx - non calendar year (HMO)	01	01		1			H3471	803	0	2023	Central Washington		1	12	1	1		2									www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)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;9b;10a;11a;11b;15;	1	2;	1					1				
H3471	804	0	1	02	01	H3471_804_0	1	1				0	0	04/27/2022	2023.01	04/27/2022 09:14:24 AM Central Daylight Time					05/31/2022 03:20:25 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO-POS (HMO-POS)	01	02		1			H3471	804	0	2023	Central Washington		1	12	1	1		2									www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(711)-		(711)-		(711)-		(711)-										1	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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H3471	805	0	1	02	01	H3471_805_0	1	1						04/27/2022	2023.01	04/27/2022 09:14:06 AM Central Daylight Time					05/31/2022 03:20:25 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO-POS Rx (HMO-POS)	01	02		1			H3471	805	0	2023	Central Washington		1	12	1	1		2									www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)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;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				
H3471	806	0	1	02	01	H3471_806_0	1	1						04/27/2022	2023.01	04/27/2022 09:13:49 AM Central Daylight Time					05/31/2022 03:20:25 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO-POS Rx - non-calendar year (HMO-POS)	01	02		1			H3471	806	0	2023	Central Washington		1	12	1	1		2									www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)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;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						06/02/2022	2023.01	06/02/2022 10:01:58 AM Mountain Daylight Time		05/27/2022 05:38:48 PM Mountain Daylight Time			06/02/2022 10:03:00 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	2023	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						06/02/2022	2023.01	06/02/2022 10:02:33 AM Mountain Daylight Time		05/27/2022 05:40:30 PM Mountain Daylight Time			06/02/2022 10:03:00 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	2023	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	1	1						05/31/2022	2023.01	05/31/2022 12:13:07 PM Eastern Daylight Time		05/31/2022 11:55:25 AM Eastern Daylight Time			05/31/2022 12:17:40 PM 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	2023	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	1	1						05/31/2022	2023.01	05/31/2022 12:13:44 PM Eastern Daylight Time		05/31/2022 11:56:33 AM Eastern Daylight Time			05/31/2022 12:17:40 PM 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	2023	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	4	1						08/03/2022	2023.01	08/03/2022 03:55:35 PM Eastern Daylight Time	08/03/2022 08:02:29 PM Eastern Daylight Time	07/30/2022 09:06:21 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare No Premium (HMO)	01	01		1			H3499	002	0	2023	Select counties in IN		2		2			2									www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	005	0	1	01	01	H3499_005_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:49:36 AM Eastern Daylight Time	08/03/2022 08:03:55 PM Eastern Daylight Time	07/30/2022 09:06:54 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	All counties in IN		2		2			1	3		1					1	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(833)202-4704		(833)202-4704		(844)917-0175		(844)917-0175		(833)202-4704		(833)202-4704		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	007	0	1	01	01	H3499_007_0	4	1						08/03/2022	2023.01	08/03/2022 03:58:09 PM Eastern Daylight Time	08/03/2022 08:05:06 PM Eastern Daylight Time	07/30/2022 09:07:25 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare Giveback (HMO)	01	01		1			H3499	007	0	2023	Select counties in IN		2		2			2									www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	008	0	1	01	01	H3499_008_0	5	1						05/26/2022	2023.01	05/26/2022 09:20:39 AM Eastern Daylight Time	08/03/2022 08:06:23 PM Eastern Daylight Time	07/30/2022 09:07:56 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare Assist (HMO)	01	01		1			H3499	008	0	2023	Select counties in IN		2		2			2									www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	801	0	1	01	01	H3499_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:14:58 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (HMO)	01	01		1			H3499	801	0	2023	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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:15:02 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Allwell Group (HMO)	01	01		1			H3499	802	0	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:15:08 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (HMO)	01	01		1			H3499	803	0	2023	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	3	1						06/03/2022	2023.01	06/03/2022 12:07:04 PM Pacific Daylight Time		06/03/2022 12:00:00 PM Pacific Daylight Time			06/03/2022 12:07:59 PM Pacific Daylight Time	HUMBOLDT SENIOR RESOURCE CENTER, INC.	Redwood Coast PACE	www.humsenior.org	Redwood  Coast PACE-Dual (PACE)	08	20		1			H3517	001	0	2023	Redwood Coast PACE-Dual		2		2			2									www.pharmastarpbm.com	www.pharmastarpbm.com	www.humsenior.org									(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						06/02/2022	2023.01	06/02/2022 10:07:11 AM Pacific Daylight Time		06/02/2022 09:50:11 AM Pacific Daylight Time			06/02/2022 10:08:20 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	2023	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						06/01/2022	2023.01	06/01/2022 01:08:05 PM Eastern Daylight Time		06/01/2022 12:53:52 PM Eastern Daylight Time			06/01/2022 01:11:16 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	2023	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						06/01/2022	2023.01	06/01/2022 01:09:06 PM Eastern Daylight Time		06/01/2022 12:53:52 PM Eastern Daylight Time			06/01/2022 01:11:16 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	2023	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	8	1				0	0	06/06/2022	2023.01	06/06/2022 01:49:22 PM Eastern Daylight Time	06/06/2022 05:03:38 PM Eastern Daylight Time				06/06/2022 05:17:28 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 2 (HMO)	01	01		1			H3528	003	0	2023	State of Connecticut		2		2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3528	006	0	1	02	01	H3528_006_0	10	1					0	06/05/2022	2023.01	06/05/2022 05:08:17 PM Eastern Daylight Time	08/05/2022 12:03:31 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 1 (HMO-POS)	01	02		1			H3528	006	0	2023	State of Connecticut		2		2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	010	0	1	01	01	H3528_010_0	8	1					0	08/04/2022	2023.01	08/04/2022 02:58:46 PM Eastern Daylight Time	08/05/2022 12:03:31 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Passage Plan 1 (HMO)	01	01		1			H3528	010	0	2023	State of Connecticut		2		2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	011	1	1	02	01	H3528_011_1	10	1						08/04/2022	2023.01	08/04/2022 02:59:36 PM Eastern Daylight Time	08/08/2022 04:12:00 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/09/2022 11:46:26 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 3 (HMO-POS)	01	02		1			H3528	011	1	2023	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		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	011	2	1	02	01	H3528_011_2	9	1						08/04/2022	2023.01	08/04/2022 03:00:05 PM Eastern Daylight Time	08/05/2022 12:03:31 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 3 (HMO-POS)	01	02		1			H3528	011	2	2023	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		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	014	0	1	01	01	H3528_014_0	9	1						08/04/2022	2023.01	08/04/2022 03:01:02 PM Eastern Daylight Time	08/05/2022 12:03:32 PM Eastern Daylight Time	08/05/2022 12:02:19 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 3 (HMO)	01	01		1			H3528	014	0	2023	State of Connecticut		2		2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	015	0	1	02	01	H3528_015_0	9	1					1	06/06/2022	2023.01	06/06/2022 02:10:55 PM Eastern Daylight Time	08/05/2022 12:03:32 PM Eastern Daylight Time	08/05/2022 12:02:20 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 2 (HMO-POS)	01	02		1			H3528	015	0	2023	State of Connecticut		2		2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	016	0	1	01	01	H3528_016_0	10	1					1	06/06/2022	2023.01	06/06/2022 02:56:31 AM Eastern Daylight Time	08/05/2022 12:03:32 PM Eastern Daylight Time	08/05/2022 12:02:20 PM Eastern Daylight Time			08/05/2022 12:59:26 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 1 (HMO)	01	01		1			H3528	016	0	2023	State of Connecticut		2		2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	801	0	1	01	01	H3528_801_0	8	1						06/03/2022	2023.01	06/03/2022 08:17:45 AM Eastern Daylight Time					06/06/2022 05:17:28 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO)	01	01		1			H3528	801	0	2023	State of Connecticut		1	3396	2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-3;3-4;5;6;7e;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;16b;	2		1					1				
H3528	805	0	1	01	01	H3528_805_0	8	1				0	0	05/31/2022	2023.01	05/31/2022 03:43:58 PM Eastern Daylight Time					06/06/2022 05:17:28 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO)	01	01		1			H3528	805	0	2023	State of Connecticut		1	200	2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-3;3-4;5;6;7e;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;16b;	2		1					1				
H3528	806	0	1	02	01	H3528_806_0	8	1						05/31/2022	2023.01	05/31/2022 03:48:49 PM Eastern Daylight Time					06/06/2022 05:17:28 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO-POS)	01	02		1			H3528	806	0	2023	U.S and Territories		1	3924	2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-3;3-4;5;6;7e;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;16b;	2		1	1	1a;1b;2;3-3;3-4;5;6;7e;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;16b;	2		1				
H3528	807	0	1	02	01	H3528_807_0	8	1				0	0	05/31/2022	2023.01	05/31/2022 03:56:28 PM Eastern Daylight Time					06/06/2022 05:17:28 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO-POS)	01	02		1			H3528	807	0	2023	U.S and Territories		1	200	2			2									www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(833)310-1182		(833)310-1182										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-3;3-4;5;6;7e;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;16b;	2		1	1	1a;1b;2;3-3;3-4;5;6;7e;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;16b;	2		1				
H3533	002	0	1	01	01	H3533_002_0	2	1	2	1	1		0	05/28/2022	2023.01	05/28/2022 09:49:19 AM Eastern Daylight Time	08/03/2022 03:37:50 PM Eastern Daylight Time	07/30/2022 06:31:10 AM Eastern Daylight Time			08/04/2022 05:53:55 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	2023	Select Counties in New York		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 11:24:13 AM Eastern Daylight Time	08/03/2022 03:35:14 PM Eastern Daylight Time	07/30/2022 06:31:34 AM Eastern Daylight Time			08/04/2022 03:23:03 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	2023	Select Counties in New York		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/29/2022	2023.01	05/29/2022 10:31:43 AM Eastern Daylight Time	08/03/2022 03:36:16 PM Eastern Daylight Time	07/30/2022 06:32:00 AM Eastern Daylight Time			08/04/2022 05:53:55 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	2023	Nassau and Suffolk counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/29/2022	2023.01	05/29/2022 10:33:39 AM Eastern Daylight Time	08/03/2022 03:36:47 PM Eastern Daylight Time	07/30/2022 06:32:24 AM Eastern Daylight Time			08/04/2022 05:53:55 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	2023	Select Counties in New York		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		0	08/01/2022	2023.01	08/01/2022 11:25:31 AM Eastern Daylight Time	08/03/2022 03:40:57 PM Eastern Daylight Time	07/30/2022 06:32:50 AM Eastern Daylight Time			08/04/2022 03:23:03 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	2023	New York City and Long Island		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/29/2022	2023.01	05/29/2022 10:37:33 AM Eastern Daylight Time	08/03/2022 03:47:42 PM Eastern Daylight Time	07/30/2022 06:33:14 AM Eastern Daylight Time			08/04/2022 05:53:55 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	2023	New York City	Select Counties in New York City	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/29/2022	2023.01	05/29/2022 10:39:25 AM Eastern Daylight Time	08/03/2022 03:48:14 PM Eastern Daylight Time	07/30/2022 06:33:40 AM Eastern Daylight Time			08/04/2022 05:53:55 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	2023	New York City	Richmond County	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 11:26:49 AM Eastern Daylight Time	08/03/2022 03:50:19 PM Eastern Daylight Time	07/30/2022 06:34:04 AM Eastern Daylight Time			08/04/2022 03:23:03 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	2023	Brooklyn and Queens		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 11:15:41 AM Eastern Daylight Time	08/03/2022 03:51:54 PM Eastern Daylight Time	07/30/2022 06:34:30 AM Eastern Daylight Time			08/04/2022 03:23:03 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	2023	New York City	Select Counties in New York City	2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 11:18:24 AM Eastern Daylight Time	08/03/2022 03:52:25 PM Eastern Daylight Time	07/30/2022 06:34:54 AM Eastern Daylight Time			08/04/2022 03:23:03 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	2023	New York City	Long Island and Select Counties in New York City	2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/27/2022	2023.01	05/27/2022 05:30:46 PM Eastern Daylight Time					05/27/2022 05:37:42 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H3533	802	0	2023	Select Counties in NY		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 05:32:14 PM Eastern Daylight Time					05/27/2022 05:37:42 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H3533	803	0	2023	Select Counties in NY		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/27/2022	2023.01	05/27/2022 05:34:58 PM Eastern Daylight Time					05/27/2022 05:37:42 PM 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	2023	Select counties in NY		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 05:37:21 PM Eastern Daylight Time					05/27/2022 05:37:42 PM 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	2023	Select counties in NY		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	5	1			2		0	07/11/2022	2023.01	07/11/2022 10:25:39 AM Eastern Daylight Time	08/04/2022 06:18:05 PM Eastern Daylight Time	08/04/2022 06:32:31 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			1		0	08/01/2022	2023.01	08/01/2022 12:27:05 PM Eastern Daylight Time	08/04/2022 06:18:06 PM Eastern Daylight Time	08/04/2022 06:32:33 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2		1	08/01/2022	2023.01	08/01/2022 12:29:14 PM Eastern Daylight Time	08/04/2022 06:18:08 PM Eastern Daylight Time	08/04/2022 06:32:36 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	2	1						05/20/2022	2023.01	05/20/2022 02:53:07 PM Pacific Daylight Time					06/03/2022 10:55:41 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3536	802	0	1	01	01	H3536_802_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 02:54:38 PM Pacific Daylight Time					06/03/2022 10:55:41 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3536	803	0	2	01	01	H3536_803_0	2	1						05/20/2022	2023.01	05/20/2022 02:56:36 PM Pacific Daylight Time					06/03/2022 10:55:41 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3536	804	0	2	01	01	H3536_804_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 02:59:00 PM Pacific Daylight Time					06/03/2022 10:55:41 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3536	806	0	1	01	01	H3536_806_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 02:59:27 PM Pacific Daylight Time					06/03/2022 10:55:41 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3536	808	0	2	01	01	H3536_808_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 02:59:46 PM Pacific Daylight Time					06/03/2022 10:55:41 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3554	002	0	1	04	01	H3554_002_0	5	1					1	08/04/2022	2023.01	08/04/2022 02:01:54 PM Central Daylight Time	08/04/2022 01:07:32 PM Central Daylight Time	08/04/2022 01:07:37 PM Central Daylight Time			08/04/2022 02:06:54 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	2023	Select Counties in Arkansas		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:02:51 PM Central Daylight Time	08/04/2022 01:07:42 PM Central Daylight Time	08/04/2022 01:07:47 PM Central Daylight Time			08/04/2022 02:06:54 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	2023	Select Counties in Arkansas		2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:03:29 PM Central Daylight Time	08/04/2022 01:07:54 PM Central Daylight Time	08/04/2022 01:07:59 PM Central Daylight Time			08/04/2022 02:06:54 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	2023	Select Counties in Arkansas		2		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	011	0	1	04	01	H3554_011_0	3	1				0	0	07/12/2022	2023.01	07/12/2022 02:39:49 PM Central Daylight Time	06/03/2022 07:06:53 PM Central Daylight Time				07/12/2022 03:19:03 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Freedom Giveback (PPO)	01	04		1			H3554	011	0	2023	Select Counties in Arkansas		2		2			2									http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3554	801	0	1	04	01	H3554_801_0	1	1						05/06/2022	2023.01	05/06/2022 11:16:58 AM Central Daylight Time					06/03/2022 05:09:19 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/abcbsretiree	BlueMedicare Premier Group CY (PPO)	01	04		1			H3554	801	0	2023	Employer Group Plan		1	999	2			2									www.arkansasbluecross.com/abcbsretiree	www.arkansasbluecross.com/abcbsretiree	www.arkansasbluecross.com/abcbsretiree	(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						05/06/2022	2023.01	05/06/2022 11:21:23 AM Central Daylight Time					06/03/2022 05:09:19 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/abcbsretiree	BlueMedicare Premier Group NCY (PPO)	01	04		1			H3554	802	0	2023	Employer Group Plan		1	999	2			2									http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/abcbsretiree	(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	05/06/2022	2023.01	05/06/2022 11:26:47 AM Central Daylight Time					06/03/2022 05:09:19 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/abcbsretiree	BlueMedicare Value Group CY (PPO)	01	04		1			H3554	803	0	2023	Employer Group Plan		1	999	2			2									http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/abcbsretiree	(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	05/06/2022	2023.01	05/06/2022 11:29:53 AM Central Daylight Time					06/03/2022 05:09:19 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/abcbsretiree	BlueMedicare Value Group NCY (PPO)	01	04		1			H3554	804	0	2023	Employer Group Plan		1	999	2			2									http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/abcbsretiree	(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	11	1					1	08/04/2022	2023.01	08/04/2022 02:34:31 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time			08/04/2022 02:38:52 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	2023	State of Rhode Island		2		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	5	1						06/06/2022	2023.01	06/06/2022 01:26:13 PM Eastern Daylight Time					06/06/2022 08:44:22 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	2023	RI, Nationwide		1	31131	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	5	1						06/03/2022	2023.01	06/03/2022 11:44:05 AM Eastern Daylight Time					06/06/2022 08:44:22 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	2023	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	5	1				0	0	06/03/2022	2023.01	06/03/2022 11:44:23 AM Eastern Daylight Time					06/06/2022 08:44:22 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	2023	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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 08:29:16 AM Pacific Daylight Time	08/03/2022 08:18:51 PM Eastern Daylight Time	07/30/2022 09:08:29 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare Dual Liberty Amber (HMO D-SNP)	01	01		1			H3561	001	0	2023	Select counties in CA		2		2			1	3		1					1	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3561	801	0	1	01	01	H3561_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:15:15 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	California		1	100	2			2									ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	www.wellcare.com/healthnetCA	(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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:15:21 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	California		1	100	2			2									ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	www.wellcare.com/healthnetCA	(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	1	1						05/10/2022	2023.01	05/10/2022 11:15:33 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	California		1	100	2			2									ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	www.wellcare.com/healthnetCA	(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						05/27/2022	2023.01	05/27/2022 12:19:11 PM Pacific Daylight Time		05/27/2022 12:13:39 PM Pacific Daylight Time			05/27/2022 12:23:24 PM 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	2023	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						05/27/2022	2023.01	05/27/2022 12:19:56 PM Pacific Daylight Time		05/27/2022 12:13:44 PM Pacific Daylight Time			05/27/2022 12:23:24 PM 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	2023	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	2	1			2			08/01/2022	2023.01	08/01/2022 05:31:25 PM Eastern Daylight Time	08/02/2022 01:27:02 PM Eastern Daylight Time	07/31/2022 10:26:28 PM Eastern Daylight Time			08/04/2022 05:38:48 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	001	0	2023	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	2	1			2			08/01/2022	2023.01	08/01/2022 05:32:26 PM Eastern Daylight Time	08/02/2022 01:27:58 PM Eastern Daylight Time	07/31/2022 10:26:54 PM Eastern Daylight Time			08/04/2022 05:38:48 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	007	0	2023	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	2	1			2			08/01/2022	2023.01	08/01/2022 05:34:11 PM Eastern Daylight Time	08/02/2022 01:28:53 PM Eastern Daylight Time	07/31/2022 10:27:18 PM Eastern Daylight Time			08/04/2022 05:38:48 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	009	0	2023	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	7	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:35:15 PM Eastern Daylight Time	08/02/2022 01:29:50 PM Eastern Daylight Time	07/31/2022 10:27:44 PM Eastern Daylight Time			08/04/2022 05:38:48 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	2023	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	05/30/2022	2023.01	05/30/2022 09:46:39 AM Eastern Daylight Time					06/02/2022 03:13:51 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3597	801	0	2023	Maine		1	280	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3597	802	0	1	01	01	H3597_802_0	1	1						05/30/2022	2023.01	05/30/2022 09:46:06 AM Eastern Daylight Time					06/02/2022 03:13:51 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	2023	Maine		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3613	001	0	1	20	08	H3613_001_0	1	1						06/01/2022	2023.01	06/01/2022 03:39:21 PM Eastern Daylight Time		06/01/2022 03:24:41 PM Eastern Daylight Time			06/01/2022 03:42:37 PM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Dual Eligibles (PACE)	08	20		1			H3613	001	0	2023	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						06/01/2022	2023.01	06/01/2022 03:40:14 PM Eastern Daylight Time		06/01/2022 03:24:01 PM Eastern Daylight Time			06/01/2022 03:42:37 PM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Medicare Only Eligibles (PACE)	08	20		1			H3613	002	0	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 09:24:14 AM Central Daylight Time	08/09/2022 08:20:20 AM Central Daylight Time	08/04/2022 02:06:04 PM Central Daylight Time			08/09/2022 10:32:40 AM Central Daylight Time	MEDICA COMMUNITY HEALTH PLAN	Medica	medica.com	Medica Advantage Solution H3632-001 (PPO)	01	04		1			H3632	001	0	2023	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						1	01	4b;	
H3653	004	0	1	01	01	H3653_004_0	7	1					1	08/03/2022	2023.01	08/03/2022 02:44:47 PM Eastern Daylight Time	08/05/2022 08:53:46 AM Eastern Daylight Time	08/05/2022 08:53:46 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Enhanced (HMO)	01	01		1			H3653	004	0	2023	Paramount Elite Enhanced (Northern OH / SE Mich)		2		2			2									paramounthealthcare.com/medicareplans	paramounthealthcare.com/medicareplans	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	7	1					0	08/03/2022	2023.01	08/03/2022 02:49:08 PM Eastern Daylight Time	08/05/2022 08:53:47 AM Eastern Daylight Time	08/05/2022 08:53:47 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Standard (HMO)	01	01		1			H3653	015	0	2023	Paramount Elite Standard (Northern OH / SE Mich)		2		2			2									paramounthealthcare.com/medicareplans	paramounthealthcare.com/medicareplans	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	07/13/2022	2023.01	07/13/2022 10:16:48 AM Eastern Daylight Time	06/06/2022 08:40:22 AM Eastern Daylight Time				07/18/2022 08:58:31 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Prevail (HMO)	01	01		1			H3653	018	0	2023	Paramount Elite Medical Only (North OH/ SE Mich)		2		2			2									paramounthealthcare.com/medicareplans	paramounthealthcare.com/medicareplans	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	7	1					1	08/03/2022	2023.01	08/03/2022 02:50:49 PM Eastern Daylight Time	08/05/2022 08:53:47 AM Eastern Daylight Time	08/05/2022 08:53:47 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Prime (HMO)	01	01		1			H3653	022	0	2023	Paramount Elite Prime (Northern OH / SE Mich)		2		2			2									paramounthealthcare.com/medicareplans	paramounthealthcare.com/medicareplans	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	08/03/2022	2023.01	08/03/2022 02:52:11 PM Eastern Daylight Time	08/05/2022 08:53:48 AM Eastern Daylight Time	08/05/2022 08:53:48 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Essential (HMO)	01	01		1			H3653	024	0	2023	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	025	0	1	01	01	H3653_025_0	7	1					0	08/03/2022	2023.01	08/03/2022 02:57:42 PM Eastern Daylight Time	08/05/2022 08:53:48 AM Eastern Daylight Time	08/05/2022 08:53:48 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	PARAMOUNT ELITE NE OHIO ENHANCED (HMO)	01	01		1			H3653	025	0	2023	NE 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	026	0	1	01	01	H3653_026_0	7	1					0	08/03/2022	2023.01	08/03/2022 02:59:28 PM Eastern Daylight Time	08/05/2022 08:53:49 AM Eastern Daylight Time	08/05/2022 08:53:49 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	PARAMOUNT ELITE NE OHIO STANDARD (HMO)	01	01		1			H3653	026	0	2023	NE 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	027	0	1	01	01	H3653_027_0	7	1					0	08/03/2022	2023.01	08/03/2022 03:00:38 PM Eastern Daylight Time	08/05/2022 08:53:50 AM Eastern Daylight Time	08/05/2022 08:53:50 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	PARAMOUNT ELITE NE OHIO PRIME (HMO)	01	01		1			H3653	027	0	2023	NE 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	028	0	1	02	01	H3653_028_0	6	1					0	08/03/2022	2023.01	08/03/2022 03:02:01 PM Eastern Daylight Time	08/05/2022 08:53:51 AM Eastern Daylight Time	08/05/2022 08:53:51 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	promedicahealthplan.com/map	MAP Medicare (HMO-POS)	01	02		1			H3653	028	0	2023	Western Ohio		2		2			2									promedicahealthplan.com/map	promedicahealthplan.com/map	promedicahealthplan.com/map	(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(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	05/26/2022	2023.01	05/26/2022 06:37:32 AM Eastern Daylight Time					05/31/2022 11:16:35 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	2023	Paramount Elite - Emp Group A/B No Rx		1	9624	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;11c;15;	2		1					1				
H3653	806	0	2	01	01	H3653_806_0	1	1				0	0	05/26/2022	2023.01	05/26/2022 06:45:38 AM Eastern Daylight Time					05/31/2022 11:16:35 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	2023	Paramount Elite - Emp Group B Only No Rx		1	852	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;11c;15;	2		1					1				
H3653	809	0	1	01	01	H3653_809_0	1	1						05/26/2022	2023.01	05/26/2022 06:54:10 AM Eastern Daylight Time					05/31/2022 11:16:35 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	2023	Paramount Elite-Emp Group A/B Rx		1	1476	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;11c;15;	2		1					1				
H3655	033	0	1	01	01	H3655_033_0	5	1	2	1	1		0	06/10/2022	2023.01	06/10/2022 04:24:35 PM Eastern Daylight Time	08/04/2022 06:16:47 PM Eastern Daylight Time	08/04/2022 06:30:04 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1			2		0	08/01/2022	2023.01	08/01/2022 04:23:14 PM Eastern Daylight Time	08/04/2022 06:16:48 PM Eastern Daylight Time	08/04/2022 06:30:07 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 04:26:26 PM Eastern Daylight Time	08/04/2022 06:16:50 PM Eastern Daylight Time	08/04/2022 06:30:10 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1			1		0	08/01/2022	2023.01	08/01/2022 04:27:13 PM Eastern Daylight Time	08/04/2022 06:16:51 PM Eastern Daylight Time	08/04/2022 06:30:12 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1			2		1	08/01/2022	2023.01	08/01/2022 04:28:59 PM Eastern Daylight Time	08/04/2022 06:16:53 PM Eastern Daylight Time	08/04/2022 06:30:15 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 12:14:48 PM Eastern Daylight Time	08/04/2022 06:16:54 PM Eastern Daylight Time	08/04/2022 06:30:18 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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		1	08/01/2022	2023.01	08/01/2022 04:31:27 PM Eastern Daylight Time	08/04/2022 06:16:56 PM Eastern Daylight Time	08/04/2022 06:30:20 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 04:33:21 PM Eastern Daylight Time	08/04/2022 06:16:57 PM Eastern Daylight Time	08/04/2022 06:30:23 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 04:33:11 PM Eastern Daylight Time	08/04/2022 06:16:58 PM Eastern Daylight Time	08/04/2022 06:30:26 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 04:34:00 PM Eastern Daylight Time	08/04/2022 06:17:00 PM Eastern Daylight Time	08/04/2022 06:30:28 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	2	1						05/20/2022	2023.01	05/20/2022 02:13:59 PM Pacific Daylight Time					06/03/2022 10:39:13 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	2023	Ohio		1	2340	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3655	803	0	1	01	01	H3655_803_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 02:14:34 PM Pacific Daylight Time					06/03/2022 10:39:13 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	2023	Ohio		1	180	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3655	805	0	2	01	01	H3655_805_0	2	1						05/20/2022	2023.01	05/20/2022 02:14:53 PM Pacific Daylight Time					06/03/2022 10:39:13 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3655	806	0	2	01	01	H3655_806_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 02:15:17 PM Pacific Daylight Time					06/03/2022 10:39:13 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3655	808	0	1	01	01	H3655_808_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 02:15:43 PM Pacific Daylight Time					06/03/2022 10:39:13 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3655	810	0	2	01	01	H3655_810_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 02:16:04 PM Pacific Daylight Time					06/03/2022 10:39:13 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H3660	028	0	1	02	01	H3660_028_0	7	1						08/05/2022	2023.01	08/05/2022 02:27:34 PM Eastern Daylight Time	08/05/2022 02:49:37 PM Eastern Daylight Time	08/05/2022 02:49:38 PM Eastern Daylight Time			08/05/2022 02:58:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Emerald (HMO-POS)	01	02		1			H3660	028	0	2023	Northeast Ohio		2		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						08/04/2022	2023.01	08/04/2022 01:08:25 PM Eastern Daylight Time	08/05/2022 02:49:39 PM Eastern Daylight Time	08/05/2022 02:49:27 PM Eastern Daylight Time			08/05/2022 02:58:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Sapphire (HMO-POS)	01	02		1			H3660	029	0	2023	Northeast & Northwest Ohio		2		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	7	1						08/04/2022	2023.01	08/04/2022 05:24:34 PM Eastern Daylight Time	08/05/2022 02:49:28 PM Eastern Daylight Time	08/05/2022 02:49:28 PM Eastern Daylight Time			08/05/2022 02:58:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	01	01		1			H3660	044	0	2023	Northeast & Northwest Ohio		2		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	7	1						08/04/2022	2023.01	08/04/2022 09:08:57 PM Eastern Daylight Time	08/05/2022 02:49:29 PM Eastern Daylight Time	08/05/2022 02:49:30 PM Eastern Daylight Time			08/05/2022 02:58:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Topaz (HMO)	01	01		1			H3660	050	0	2023	Northeast Ohio		2		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	7	1				0	0	07/11/2022	2023.01	07/11/2022 02:57:28 PM Eastern Daylight Time	07/19/2022 01:11:03 PM Eastern Daylight Time				07/19/2022 01:21:23 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Amber (HMO)	01	01		1			H3660	052	1	2023	Northeast and Northwest Ohio	Northeast Ohio	2		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)750-0750		(800)750-0750		(800)750-0750		(800)750-0750										2					2					2	2			
H3660	052	2	1	01	01	H3660_052_2	7	1				0	0	07/11/2022	2023.01	07/11/2022 02:59:33 PM Eastern Daylight Time	07/19/2022 01:11:03 PM Eastern Daylight Time				07/19/2022 01:21:23 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Amber (HMO)	01	01		1			H3660	052	2	2023	Northeast and Northwest Ohio	Northwest Ohio	2		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)750-0750		(800)750-0750		(800)750-0750		(800)750-0750										2					2					2	2			
H3660	053	1	1	01	01	H3660_053_1	7	1						08/04/2022	2023.01	08/04/2022 09:15:43 PM Eastern Daylight Time	08/05/2022 02:49:31 PM Eastern Daylight Time	08/05/2022 02:49:32 PM Eastern Daylight Time			08/05/2022 02:58:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Garnet (HMO)	01	01		1			H3660	053	1	2023	Northeast & Northwest Ohio	Summit, Stark, Portage, Medina and Wayne Counties	2		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	7	1						08/04/2022	2023.01	08/04/2022 09:12:17 PM Eastern Daylight Time	08/05/2022 02:49:32 PM Eastern Daylight Time	08/05/2022 02:49:33 PM Eastern Daylight Time			08/05/2022 02:58:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Garnet (HMO)	01	01		1			H3660	053	2	2023	Northeast & Northwest Ohio	CUY GEA LAK LOR MAH TRU ERI HUR OTT SAN SEN	2		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	056	1	1	01	01	H3660_056_1	8	1						08/10/2022	2023.01	08/10/2022 01:43:30 PM Eastern Daylight Time	08/05/2022 02:49:34 PM Eastern Daylight Time	08/05/2022 02:49:35 PM Eastern Daylight Time			08/10/2022 02:20:06 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Jade (HMO)	01	01		1			H3660	056	1	2023	Northeast & Northwest Ohio	Northeast Ohio	2		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	056	2	1	01	01	H3660_056_2	8	1						08/10/2022	2023.01	08/10/2022 01:44:49 PM Eastern Daylight Time	08/05/2022 02:49:35 PM Eastern Daylight Time	08/05/2022 02:49:36 PM Eastern Daylight Time			08/10/2022 02:20:06 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Jade (HMO)	01	01		1			H3660	056	2	2023	Northeast & Northwest Ohio	Northwest Ohio	2		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	4	1						06/03/2022	2023.01	06/03/2022 01:27:52 PM Eastern Daylight Time					06/05/2022 11:48:45 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	2023	Nationwide Service Area		1	302	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;8a;8b1;8b2;8b3;9a1;9b;15;	2		2					1				
H3660	802	0	1	01	01	H3660_802_0	4	1				0	0	04/27/2022	2023.01	04/27/2022 09:38:04 PM Eastern Daylight Time					06/05/2022 11:48:45 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan without Part D (HMO)	01	01		1			H3660	802	0	2023	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;8a;8b1;8b2;8b3;9a1;9b;15;	2		1					1				
H3660	805	0	1	02	01	H3660_805_0	4	1						04/27/2022	2023.01	04/27/2022 09:34:25 PM Eastern Daylight Time					06/05/2022 11:48:45 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	2023	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;8a;8b1;8b2;8b3;9a1;9b;15;	2		1	2		2		1				
H3660	806	0	1	02	01	H3660_806_0	4	1				0	0	04/27/2022	2023.01	04/27/2022 09:32:46 PM Eastern Daylight Time					06/05/2022 11:48:45 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan without Part D (HMO-POS)	01	02		1			H3660	806	0	2023	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;15;	2		1	2		2		1				
H3664	014	0	1	02	01	H3664_014_0	3	1				0	0	08/03/2022	2023.01	08/03/2022 03:46:15 PM Eastern Daylight Time	06/05/2022 05:38:51 PM Eastern Daylight Time				08/05/2022 09:25:17 AM 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	2023	Operating in 12 counties in Northeastern Ohio		2		2			2									www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3664	017	0	1	02	01	H3664_017_0	3	1					1	08/03/2022	2023.01	08/03/2022 04:37:21 PM Eastern Daylight Time	08/05/2022 08:51:17 AM Eastern Daylight Time	08/05/2022 08:51:18 AM Eastern Daylight Time			08/05/2022 09:25:17 AM 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	2023	Operating in 12 counties in Northeastern Ohio		2		2			2									www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3664	020	0	1	02	01	H3664_020_0	3	1					1	08/03/2022	2023.01	08/03/2022 04:37:45 PM Eastern Daylight Time	08/05/2022 08:51:18 AM Eastern Daylight Time	08/05/2022 08:51:18 AM Eastern Daylight Time			08/05/2022 09:25:17 AM 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	2023	Operating in 12 counties in Northeastern Ohio		2		2			2									www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3664	021	0	1	02	01	H3664_021_0	3	1					1	08/03/2022	2023.01	08/03/2022 04:37:59 PM Eastern Daylight Time	08/05/2022 08:51:18 AM Eastern Daylight Time	08/05/2022 08:51:19 AM Eastern Daylight Time			08/05/2022 09:25:17 AM 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	2023	Operating in 12 counties in Northeastern Ohio		2		2			2									www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3664	801	0	1	02	01	H3664_801_0	2	1						05/11/2022	2023.01	05/11/2022 09:54:48 AM Eastern Daylight Time					06/05/2022 05:43:18 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	2023	National Service Area		1	4992	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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	04/27/2022	2023.01	04/27/2022 04:56:30 PM Eastern Daylight Time					06/05/2022 05:43:18 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	2023	National Service Area		1	9468	2			2									www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(711)-		(711)-		(711)-		(711)-										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						04/27/2022	2023.01	04/27/2022 04:56:51 PM Eastern Daylight Time					06/05/2022 05:43:18 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						04/27/2022	2023.01	04/27/2022 04:58:21 PM Eastern Daylight Time					06/05/2022 05:43:18 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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	04/27/2022	2023.01	04/27/2022 04:59:51 PM Eastern Daylight Time					06/05/2022 05:43:18 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	2023	Part B Only MA National Service Area		1	1344	2			2									www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(711)-		(711)-		(711)-		(711)-										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						04/27/2022	2023.01	04/27/2022 05:00:59 PM Eastern Daylight Time					06/05/2022 05:43:18 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	2023	National Service Area		1	1176	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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	3	1				0	0	07/12/2022	2023.01	07/12/2022 07:02:21 AM Eastern Daylight Time	06/06/2022 05:18:14 AM Eastern Daylight Time				07/12/2022 08:35:24 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel Cash Back No Premium MA Only (HMO)	01	01		1			H3668	013	0	2023	Central, Southwest, and Northwest 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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3668	018	1	1	01	01	H3668_018_1	4	1					1	08/04/2022	2023.01	08/04/2022 08:49:43 AM Eastern Daylight Time	08/04/2022 05:53:35 PM Eastern Daylight Time	08/04/2022 05:53:36 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel Premier (HMO)	01	01		1			H3668	018	1	2023	Central and Southwest Ohio	Central 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	4	1					1	08/04/2022	2023.01	08/04/2022 08:51:02 AM Eastern Daylight Time	08/04/2022 05:53:36 PM Eastern Daylight Time	08/04/2022 05:53:37 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel Premier (HMO)	01	01		1			H3668	018	2	2023	Central and Southwest Ohio	Southwest 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	4	1					1	08/04/2022	2023.01	08/04/2022 08:52:16 AM Eastern Daylight Time	08/04/2022 05:53:37 PM Eastern Daylight Time	08/04/2022 05:53:37 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel No Premium (HMO)	01	01		1			H3668	019	1	2023	Central and Southwest Ohio	Central 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	4	1					1	08/04/2022	2023.01	08/04/2022 08:53:34 AM Eastern Daylight Time	08/04/2022 05:53:38 PM Eastern Daylight Time	08/04/2022 05:53:38 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel No Premium (HMO)	01	01		1			H3668	019	2	2023	Central and Southwest Ohio	Southwest 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	4	1					1	08/04/2022	2023.01	08/04/2022 08:54:55 AM Eastern Daylight Time	08/04/2022 05:53:39 PM Eastern Daylight Time	08/04/2022 05:53:39 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel No Premium (HMO)	01	01		1			H3668	020	0	2023	Northwest 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	4	1					1	08/04/2022	2023.01	08/04/2022 08:56:19 AM Eastern Daylight Time	08/04/2022 05:53:40 PM Eastern Daylight Time	08/04/2022 05:53:41 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel Plus (HMO)	01	01		1			H3668	022	0	2023	Central 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	4	1					1	08/04/2022	2023.01	08/04/2022 08:58:09 AM Eastern Daylight Time	08/04/2022 05:53:24 PM Eastern Daylight Time	08/04/2022 05:53:25 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel Plus (HMO)	01	01		1			H3668	023	0	2023	Southwest 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	4	1					1	08/04/2022	2023.01	08/04/2022 10:11:59 AM Eastern Daylight Time	08/04/2022 05:53:25 PM Eastern Daylight Time	08/04/2022 05:53:26 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold MercyOne Medicare Plan No Premium (HMO)	01	01		1			H3668	025	0	2023	Select Counties in Iowa		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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	4	1					1	08/04/2022	2023.01	08/04/2022 10:13:11 AM Eastern Daylight Time	08/04/2022 05:53:26 PM Eastern Daylight Time	08/04/2022 05:53:27 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold MercyOne Medicare Plan Plus (HMO)	01	01		1			H3668	026	0	2023	Select Counties in Iowa		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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	3	1				0	0	07/12/2022	2023.01	07/12/2022 07:09:26 AM Eastern Daylight Time	06/06/2022 05:18:08 AM Eastern Daylight Time				07/12/2022 08:35:24 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold MercyOne Medicare Plan Cash Back (HMO)	01	01		1			H3668	029	0	2023	Select Counties in Iowa		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	www.medigold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3668	030	0	1	01	01	H3668_030_0	4	1					0	08/04/2022	2023.01	08/04/2022 08:59:53 AM Eastern Daylight Time	08/04/2022 05:53:27 PM Eastern Daylight Time	08/04/2022 05:53:28 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel Cash Back No Premium (HMO)	01	01		1			H3668	030	0	2023	Central, Southwest, and Northwest 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	031	0	1	01	01	H3668_031_0	4	1					0	08/04/2022	2023.01	08/04/2022 10:14:29 AM Eastern Daylight Time	08/04/2022 05:53:28 PM Eastern Daylight Time	08/04/2022 05:53:29 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold MercyOne Medicare Plan Cash Back MAPD (HMO)	01	01		1			H3668	031	0	2023	Select Counties in Iowa		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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	802	0	1	01	01	H3668_802_0	2	1						05/26/2022	2023.01	05/26/2022 02:13:51 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel Trinity EGWP (HMO)	01	01		1			H3668	802	0	2023	Central, Southwest, and Northwest Ohio		1	6300	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	803	0	1	01	01	H3668_803_0	2	1						05/26/2022	2023.01	05/26/2022 02:18:15 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel EGWP 1 (HMO)	01	01		1			H3668	803	0	2023	Central, Southwest, and Northwest 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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	804	0	1	01	01	H3668_804_0	2	1						05/26/2022	2023.01	05/26/2022 02:22:39 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Mount Carmel EGWP 2 (HMO)	01	01		1			H3668	804	0	2023	Central, Southwest, and Northwest 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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	811	0	1	01	01	H3668_811_0	1	1						06/02/2022	2023.01	06/02/2022 12:28:07 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold MercyOne Medicare Plan EGWP 1 (HMO)	01	01		1			H3668	811	0	2023	Select Counties in Iowa		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	812	0	1	01	01	H3668_812_0	1	1						06/02/2022	2023.01	06/02/2022 12:31:31 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold MercyOne Medicare Plan EGWP 2 (HMO)	01	01		1			H3668	812	0	2023	Select Counties in Iowa		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3672	013	0	1	01	01	H3672_013_0	7	1			2			08/04/2022	2023.01	08/04/2022 01:34:01 PM Eastern Daylight Time	08/05/2022 04:00:31 PM Eastern Daylight Time	07/30/2022 12:22:24 PM Eastern Daylight Time			08/05/2022 04:11:37 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	2023	East Central Ohio		2		2			2									www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	014	0	1	01	01	H3672_014_0	3	1			2	0	0	06/30/2022	2023.01	06/30/2022 03:31:18 PM Eastern Daylight Time	06/01/2022 11:45:36 AM Eastern Daylight Time				07/05/2022 10:10:09 AM 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	2023	East Central Ohio		2		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	7	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 01:36:30 PM Eastern Daylight Time	08/05/2022 04:00:32 PM Eastern Daylight Time	07/30/2022 12:23:54 PM Eastern Daylight Time			08/05/2022 04:11:37 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	2023	Southeastern Ohio, West Virginia		2		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	7	1			2			06/30/2022	2023.01	06/30/2022 03:32:19 PM Eastern Daylight Time	08/05/2022 05:23:20 PM Eastern Daylight Time	07/30/2022 12:25:22 PM Eastern Daylight Time			08/05/2022 05:28:15 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	2023	Southeastern OH, West Virginia		2		2			2									www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	021	0	1	01	01	H3672_021_0	3	1			2	0	0	06/30/2022	2023.01	06/30/2022 03:32:47 PM Eastern Daylight Time	06/01/2022 11:49:40 AM Eastern Daylight Time				07/05/2022 10:10:09 AM 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	2023	Southeastern OH, West Virginia		2		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			2			08/04/2022	2023.01	08/04/2022 01:34:21 PM Eastern Daylight Time	08/05/2022 04:00:32 PM Eastern Daylight Time	07/30/2022 12:26:50 PM Eastern Daylight Time			08/05/2022 04:11:37 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	2023	Kanawha and Surrounding Counties		2		2			2									www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	024	0	1	01	01	H3672_024_0	3	1			2	0	0	06/30/2022	2023.01	06/30/2022 03:33:42 PM Eastern Daylight Time	06/01/2022 11:51:40 AM Eastern Daylight Time				07/05/2022 10:10:09 AM 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	2023	Kanawha and Surrounding Counties		2		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	2	1						06/06/2022	2023.01	06/06/2022 04:34:53 PM Eastern Daylight Time					06/06/2022 04:38:42 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	2023	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	8	1			2		0	07/21/2022	2023.01	07/21/2022 07:18:29 AM Central Daylight Time	08/04/2022 09:06:58 AM Central Daylight Time	08/01/2022 10:29:14 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/Oklahoma/medicare	Generations Classic Rewards (HMO)	01	01		1			H3706	001	0	2023	Oklahoma (Partial)		2		2			2									www.GlobalHealth.com/Oklahoma/pharmacy-directories	www.globalhealth.com/Oklahoma/pharmacy/drug-formularies	www.GlobalHealth.com/Oklahoma/provider-search	(844)280-5555		(405)280-5555		(844)498-1164		(405)280-5874		(866)494-3927		(866)494-3927		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	009	0	1	02	01	H3706_009_0	6	1			2	0	0	07/13/2022	2023.01	07/13/2022 07:11:57 AM Central Daylight Time	07/13/2022 03:59:48 PM Central Daylight Time				07/18/2022 07:47:45 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/Oklahoma/medicare	Generations Valor (HMO-POS)	01	02		1			H3706	009	0	2023	Oklahoma (Partial)		2		2			2									www.GlobalHealth.com/Oklahoma/pharmacy-directories	www.globalhealth.com/Oklahoma/pharmacy/drug-formularies	www.GlobalHealth.com/Oklahoma/provider-search	(844)280-5555		(405)280-5555		(844)498-1164		(405)280-5874										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3706	023	0	1	01	01	H3706_023_0	8	1			2		0	07/13/2022	2023.01	07/13/2022 07:12:35 AM Central Daylight Time	08/04/2022 09:08:28 AM Central Daylight Time	08/01/2022 10:29:46 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/Oklahoma/medicare	Generations Classic Plus (HMO)	01	01		1			H3706	023	0	2023	Oklahoma City Metro		2		2			2									www.GlobalHealth.com/Oklahoma/pharmacy-directories	www.globalhealth.com/Oklahoma/pharmacy/drug-formularies	www.GlobalHealth.com/Oklahoma/provider-search	(844)280-5555		(405)280-5555		(844)498-1164		(405)280-5874		(866)494-3927		(866)494-3927		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	024	0	1	01	01	H3706_024_0	8	1		1	2		1	07/13/2022	2023.01	07/13/2022 07:13:55 AM Central Daylight Time	08/04/2022 09:09:14 AM Central Daylight Time	08/01/2022 10:30:18 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/Oklahoma/medicare	Generations Chronic Care (HMO C-SNP)	01	01		1			H3706	024	0	2023	Partial Oklahoma		2		2			1	4			00000000000000000010000					www.GlobalHealth.com/Oklahoma/pharmacy-directories	www.globalhealth.com/Oklahoma/pharmacy/drug-formularies	www.GlobalHealth.com/Oklahoma/provider-search	(844)280-5555		(405)280-5555		(844)498-1164		(405)280-5874		(866)494-3927		(866)494-3927		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	025	0	1	01	01	H3706_025_0	8	1		1	2		1	07/13/2022	2023.01	07/13/2022 07:15:26 AM Central Daylight Time	08/04/2022 09:09:58 AM Central Daylight Time	08/01/2022 10:30:50 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/Oklahoma/medicare	Generations Chronic Care Savings (HMO C-SNP)	01	01		1			H3706	025	0	2023	Partial Oklahoma		2		2			1	4			00000000000000000010000					www.GlobalHealth.com/Oklahoma/pharmacy-directories	www.globalhealth.com/Oklahoma/pharmacy/drug-formularies	www.GlobalHealth.com/Oklahoma/provider-search	(844)280-5555		(405)280-5555		(844)498-1164		(405)280-5874		(866)494-3927		(866)494-3927		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	028	0	1	01	01	H3706_028_0	9	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 07:19:46 AM Central Daylight Time	08/04/2022 09:10:42 AM Central Daylight Time	08/01/2022 10:31:24 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/Oklahoma/medicare	Generations Dual Support (HMO D-SNP)	01	01		1			H3706	028	0	2023	Oklahoma (Partial)		2		2			1	3		1					1	www.GlobalHealth.com/Oklahoma/pharmacy-directories	www.globalhealth.com/Oklahoma/pharmacy/drug-formularies	www.GlobalHealth.com/Oklahoma/provider-search	(844)280-5555		(405)280-5555		(844)498-1164		(405)280-5874		(866)494-3927		(866)494-3927		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	029	0	1	01	01	H3706_029_0	8	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 04:49:10 PM Central Daylight Time	08/04/2022 09:11:26 AM Central Daylight Time	08/01/2022 10:31:58 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/Oklahoma/medicare	Generations Dual Premier (HMO D-SNP)	01	01		1			H3706	029	0	2023	Oklahoma (Partial)		2		2			1	3		1					1	www.GlobalHealth.com/Oklahoma/pharmacy-directories	www.globalhealth.com/Oklahoma/pharmacy/drug-formularies	www.GlobalHealth.com/Oklahoma/provider-search	(844)280-5555		(405)280-5555		(844)498-1164		(405)280-5874		(866)494-3927		(866)494-3927		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	803	0	1	01	01	H3706_803_0	3	1						04/13/2022	2023.01	04/13/2022 05:49:09 AM Central Daylight Time					06/06/2022 01:31:30 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/Oklahoma/medicare	Generations EGHP CY (HMO)	01	01		1			H3706	803	0	2023	Oklahoma (Partial)		1	25622	2			2									www.GlobalHealth.com/Oklahoma/pharmacy-directories	www.globalhealth.com/Oklahoma/pharmacy/drug-formularies	www.GlobalHealth.com/Oklahoma/provider-search	(844)280-5555		(405)280-5555		(844)498-1164		(405)280-5874		(866)494-3927		(866)494-3927		(844)498-1164		(405)280-5874		(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;8a;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;9a1;9a2;12;16b;17a;18a;	1					2				
H3708	001	0	1	01	01	H3708_001_0	5	1		1				08/02/2022	2023.01	08/02/2022 12:04:04 PM Central Daylight Time	08/01/2022 10:54:13 PM Central Daylight Time	07/29/2022 05:37:55 PM Central Daylight Time			08/03/2022 09:32:37 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	2023	Central and East Oklahoma		2		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	1	01	7c;7i;	
H3727	001	1	1	01	01	H3727_001_1	9	1		1			1	08/10/2022	2023.01	08/10/2022 02:43:37 PM Eastern Daylight Time	08/04/2022 06:19:59 PM Eastern Daylight Time	08/04/2022 06:20:01 PM Eastern Daylight Time			08/10/2022 02:49:11 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	2023	Indiana, Maryland and Ohio	Hamilton, Hancock, Hendricks, Johnson & Marion	2		2			1	4			00000000000000000010000					www.communicare-advantage.com	www.communicare-advantage.com	www.communicare-advantage.com	(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(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	9	1		1			1	08/10/2022	2023.01	08/10/2022 02:39:20 PM Eastern Daylight Time	08/04/2022 06:20:04 PM Eastern Daylight Time	08/04/2022 06:20:06 PM Eastern Daylight Time			08/10/2022 02:49:11 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	2023	Indiana, Maryland and Ohio	Baltimore, Baltimore City & Anne Arundel	2		2			1	4			00000000000000000010000					www.communicare-advantage.com	www.communicare-advantage.com	www.communicare-advantage.com	(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(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	9	1		1			1	08/10/2022	2023.01	08/10/2022 02:40:40 PM Eastern Daylight Time	08/04/2022 06:20:08 PM Eastern Daylight Time	08/04/2022 06:20:11 PM Eastern Daylight Time			08/10/2022 02:49:11 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	2023	Indiana, Maryland and Ohio	Butler, Cuyahoga, Hamilton, Lorain, Montgomery	2		2			1	4			00000000000000000010000					www.communicare-advantage.com	www.communicare-advantage.com	www.communicare-advantage.com	(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(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	7	1		1			0	08/05/2022	2023.01	08/05/2022 12:12:41 PM Eastern Daylight Time	08/04/2022 06:20:13 PM Eastern Daylight Time	08/04/2022 06:20:15 PM Eastern Daylight Time			08/05/2022 01:31:27 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	2023	Indiana, Maryland and Ohio	Indiana	2		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	7	1		1			0	08/05/2022	2023.01	08/05/2022 12:11:21 PM Eastern Daylight Time	08/04/2022 06:20:17 PM Eastern Daylight Time	08/04/2022 06:20:20 PM Eastern Daylight Time			08/05/2022 01:31:27 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	2023	Indiana, Maryland and Ohio	Maryland	2		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	7	1		1			0	08/05/2022	2023.01	08/05/2022 12:14:10 PM Eastern Daylight Time	08/04/2022 06:20:22 PM Eastern Daylight Time	08/04/2022 06:20:24 PM Eastern Daylight Time			08/05/2022 01:31:27 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	2023	Indiana, Maryland and Ohio	Ohio	2		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						08/02/2022	2023.01	08/02/2022 05:29:43 PM Eastern Daylight Time	08/02/2022 03:15:11 PM Eastern Daylight Time	07/31/2022 10:28:10 PM Eastern Daylight Time			08/04/2022 06:08:03 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	2023	Spokane and Stevens 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	003	0	1	02	01	H3748_003_0	3	1						08/10/2022	2023.01	08/10/2022 03:01:09 PM Eastern Daylight Time	08/02/2022 03:16:11 PM Eastern Daylight Time	07/31/2022 10:28:36 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:01:51 PM Eastern Daylight Time	08/02/2022 03:17:13 PM Eastern Daylight Time	07/31/2022 10:29:02 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:02:24 PM Eastern Daylight Time	08/02/2022 03:18:16 PM Eastern Daylight Time	07/31/2022 10:29:28 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	3	1						08/10/2022	2023.01	08/10/2022 03:03:11 PM Eastern Daylight Time	08/02/2022 03:19:19 PM Eastern Daylight Time	07/31/2022 10:29:54 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	4	1						08/10/2022	2023.01	08/10/2022 03:03:36 PM Eastern Daylight Time	08/02/2022 03:20:21 PM Eastern Daylight Time	07/31/2022 10:30:20 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	Spokane and Stevens 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	008	0	1	02	01	H3748_008_0	3	1						08/10/2022	2023.01	08/10/2022 03:04:00 PM Eastern Daylight Time	08/02/2022 03:21:22 PM Eastern Daylight Time	07/31/2022 10:30:46 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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						08/10/2022	2023.01	08/10/2022 03:04:31 PM Eastern Daylight Time	08/02/2022 03:22:24 PM Eastern Daylight Time	07/31/2022 10:31:12 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	010	0	1	02	01	H3748_010_0	3	1						08/10/2022	2023.01	08/10/2022 03:05:05 PM Eastern Daylight Time	08/02/2022 03:23:25 PM Eastern Daylight Time	07/31/2022 10:31:38 PM Eastern Daylight Time			08/10/2022 03:45:21 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	010	0	2023	Mason 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	011	0	1	02	01	H3748_011_0	3	1						08/10/2022	2023.01	08/10/2022 03:05:37 PM Eastern Daylight Time	08/02/2022 03:24:25 PM Eastern Daylight Time	07/31/2022 10:32:04 PM Eastern Daylight Time			08/10/2022 03:45:21 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO-POS)	01	02		1			H3748	011	0	2023	Mason 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	801	0	1	01	01	H3748_801_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 09:39:39 AM Eastern Daylight Time					06/02/2022 03:15:19 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	2023	Washington		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3748	802	0	1	01	01	H3748_802_0	1	1						05/30/2022	2023.01	05/30/2022 09:40:21 AM Eastern Daylight Time					06/02/2022 03:15:19 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	2023	Washington		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3749	001	0	1	02	01	H3749_001_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 04:59:28 PM Central Daylight Time	08/03/2022 11:04:05 AM Central Daylight Time	07/31/2022 02:24:23 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex (HMO-POS)	01	02		1			H3749	001	0	2023	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	2			
H3749	017	0	1	02	01	H3749_017_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 05:01:57 PM Central Daylight Time	08/03/2022 11:04:46 AM Central Daylight Time	07/31/2022 02:24:48 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plus (HMO-POS)	01	02		1			H3749	017	0	2023	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	2			
H3749	018	0	1	02	01	H3749_018_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 05:04:45 PM Central Daylight Time	08/03/2022 11:05:28 AM Central Daylight Time	07/31/2022 02:25:12 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H3749	018	0	2023	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	2			
H3749	020	0	1	02	01	H3749_020_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 05:07:34 PM Central Daylight Time	08/03/2022 11:06:09 AM Central Daylight Time	07/31/2022 02:25:37 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Navigate (HMO-POS)	01	02		1			H3749	020	0	2023	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	2			
H3749	801	0	1	01	01	H3749_801_0	1	1				0	0	06/03/2022	2023.01	06/03/2022 09:52:50 AM Central Daylight Time					06/03/2022 03:22:53 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	801	0	2023	OK Employer Sponsored Plan Service Area		1	336	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						06/03/2022	2023.01	06/03/2022 09:53:07 AM Central Daylight Time					06/03/2022 03:22:53 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	803	0	2023	OK Employer Sponsored Plan Service Area		1	4284	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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						06/03/2022	2023.01	06/03/2022 09:53:52 AM Central Daylight Time					06/03/2022 03:22:53 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	804	0	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 04:18:14 PM Central Daylight Time	08/05/2022 06:49:20 AM Central Daylight Time	08/05/2022 06:49:21 AM Central Daylight Time			08/05/2022 06:50:50 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2023/SHP	Senior Health Plan Platinum (HMO)	01	01		1			H3755	001	0	2023	Select counties in N.E. Oklahoma		2		2			2									www.ccokadvantage.com/2023/SHP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_23.html	www.ccokadvantage.com/2023/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	6	1				0	0	06/29/2022	2023.01	06/29/2022 01:33:42 PM Central Daylight Time	06/04/2022 06:47:50 AM Central Daylight Time				06/29/2022 01:36:24 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2023/SHP	Senior Health Plan Silver (HMO)	01	01		1			H3755	002	0	2023	Select counties in N.E. Oklahoma		2		2			2									www.ccokadvantage.com/2023/shp/pharmacy-and-Rx-info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_23.html	www.ccokadvantage.com/2023/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	08/04/2022	2023.01	08/04/2022 04:19:55 PM Central Daylight Time	08/05/2022 06:49:20 AM Central Daylight Time	08/05/2022 06:49:21 AM Central Daylight Time			08/05/2022 06:50:50 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2023/SHP	Senior Health Plan Platinum Plus (HMO)	01	01		1			H3755	004	0	2023	Select counties in N.E. Oklahoma		2		2			2									www.ccokadvantage.com/2023/SHP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_23.html	www.ccokadvantage.com/2023/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	6	1					1	08/04/2022	2023.01	08/04/2022 04:20:59 PM Central Daylight Time	08/05/2022 06:49:20 AM Central Daylight Time	08/05/2022 06:49:21 AM Central Daylight Time			08/05/2022 06:50:50 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2023/SHP	Senior Health Plan Silver Plus (HMO)	01	01		1			H3755	005	0	2023	Select counties in N.E. Oklahoma		2		2			2									www.ccokadvantage.com/2023/SHP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_23.html	www.ccokadvantage.com/2023/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	3	1						06/04/2022	2023.01	06/04/2022 06:52:28 AM Central Daylight Time					06/04/2022 06:57:47 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2023/SHP	Senior Health EGHP+D (HMO)	01	01		1			H3755	801	0	2023	Select counties in N.E. Oklahoma		1	2000	2			2									www.ccokadvantage.com/2023/SHP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_23.html	www.ccokadvantage.com/2023/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;7c;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;12;14a;14d;14e2;16b;	1	5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;12;14a;14d;16b;	1					1				
H3777	001	2	1	01	01	H3777_001_2	7	1					1	08/03/2022	2023.01	08/03/2022 11:01:08 AM Eastern Daylight Time	08/03/2022 11:57:54 AM Eastern Daylight Time	08/03/2022 12:19:12 PM Eastern Daylight Time			08/03/2022 12:54:30 PM Eastern Daylight Time	EXPERIENCE HEALTH, INC.	Experience Health, Inc.	www.experiencehealthnc.com	Experience Health Medicare Advantage (HMO)	01	01		1			H3777	001	2	2023	Triangle and surrounding area	Durham Region	2		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	7	1					1	08/03/2022	2023.01	08/03/2022 11:00:46 AM Eastern Daylight Time	08/03/2022 12:02:51 PM Eastern Daylight Time	08/03/2022 12:22:30 PM Eastern Daylight Time			08/03/2022 12:54:30 PM Eastern Daylight Time	EXPERIENCE HEALTH, INC.	Experience Health, Inc.	www.experiencehealthnc.com	Experience Health Medicare Advantage (HMO)	01	01		1			H3777	001	3	2023	Triangle and surrounding area	Orange Region	2		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	7	1					1	08/03/2022	2023.01	08/03/2022 11:00:59 AM Eastern Daylight Time	08/03/2022 12:07:45 PM Eastern Daylight Time	08/03/2022 12:25:40 PM Eastern Daylight Time			08/03/2022 12:54:30 PM Eastern Daylight Time	EXPERIENCE HEALTH, INC.	Experience Health, Inc.	www.experiencehealthnc.com	Experience Health Medicare Advantage (HMO)	01	01		1			H3777	001	4	2023	Triangle and surrounding area	Raleigh Region	2		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	02	01	H3794_002_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:12:33 PM Central Daylight Time	08/03/2022 10:51:07 AM Central Daylight Time	07/31/2022 02:26:01 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO-POS D-SNP)	01	02		1			H3794	002	0	2023	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			
H3794	004	0	1	02	01	H3794_004_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:23:50 PM Central Daylight Time	08/03/2022 10:51:48 AM Central Daylight Time	07/31/2022 02:26:27 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H3794	004	0	2023	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	12	1		1				08/04/2022	2023.01	08/04/2022 05:41:03 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time			08/04/2022 09:42:14 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	2023	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	10	1		1				08/04/2022	2023.01	08/04/2022 05:42:13 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time			08/04/2022 09:42:14 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	2023	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	02	01	H3805_001_0	2	1					1	05/31/2022	2023.01	05/31/2022 10:52:51 AM Central Daylight Time	08/03/2022 10:38:00 AM Central Daylight Time	07/31/2022 02:26:51 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H3805	001	0	2023	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	015	0	1	02	01	H3805_015_0	2	1					1	05/31/2022	2023.01	05/31/2022 10:54:05 AM Central Daylight Time	08/03/2022 10:38:34 AM Central Daylight Time	07/31/2022 02:27:16 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO-POS)	01	02		1			H3805	015	0	2023	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	02	01	H3805_017_0	2	1					1	08/02/2022	2023.01	08/02/2022 01:50:37 PM Central Daylight Time	08/03/2022 10:39:08 AM Central Daylight Time	07/31/2022 02:27:40 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H3805	017	0	2023	Select Counties in West 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	032	0	1	02	01	H3805_032_0	2	1					1	08/02/2022	2023.01	08/02/2022 01:53:20 PM Central Daylight Time	08/03/2022 10:39:41 AM Central Daylight Time	07/31/2022 02:28:04 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO-POS)	01	02		1			H3805	032	0	2023	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	033	0	1	02	01	H3805_033_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:00:20 AM Central Daylight Time	08/03/2022 10:40:14 AM Central Daylight Time	07/31/2022 02:28:29 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H3805	033	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 11:08:19 AM Central Daylight Time	08/03/2022 10:40:47 AM Central Daylight Time	07/31/2022 02:28:53 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H3805	034	0	2023	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	1	1				0	0	05/31/2022	2023.01	05/31/2022 11:01:09 AM Central Daylight Time	06/01/2022 10:44:28 AM Central Daylight Time				06/03/2022 11:13:47 AM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H3805	035	0	2023	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	02	01	H3805_036_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:11:46 AM Central Daylight Time	08/03/2022 10:41:20 AM Central Daylight Time	07/31/2022 02:29:18 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H3805	036	0	2023	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	02	01	H3805_037_0	2	1					1	05/31/2022	2023.01	05/31/2022 11:04:23 AM Central Daylight Time	08/03/2022 10:41:54 AM Central Daylight Time	07/31/2022 02:29:42 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H3805	037	0	2023	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	06/03/2022	2023.01	06/03/2022 10:36:42 AM Eastern Daylight Time					06/03/2022 03:28:54 PM Eastern Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	801	0	2023	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						06/03/2022	2023.01	06/03/2022 10:36:54 AM Eastern Daylight Time					06/03/2022 03:28:54 PM Eastern Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	803	0	2023	OR Employer Sponsored Plan Service Area		1	1248	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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						06/03/2022	2023.01	06/03/2022 10:37:07 AM Eastern Daylight Time					06/03/2022 03:28:54 PM Eastern Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	804	0	2023	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	06/03/2022	2023.01	06/03/2022 10:37:18 AM Eastern Daylight Time					06/03/2022 03:28:54 PM Eastern Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	805	0	2023	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						06/03/2022	2023.01	06/03/2022 10:37:30 AM Eastern Daylight Time					06/03/2022 03:28:54 PM Eastern Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	806	0	2023	Select counties in Washington		1	2340	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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						06/03/2022	2023.01	06/03/2022 10:37:42 AM Eastern Daylight Time					06/03/2022 03:28:54 PM Eastern Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	807	0	2023	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						05/26/2022	2023.01	05/26/2022 01:35:25 PM Pacific Daylight Time		05/26/2022 01:28:41 PM Pacific Daylight Time			05/26/2022 01:37:18 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	2023	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	https://www.providence.org/services/pace-and-adult-day-programs/elderplace-in-oregon										(855)415-6048		(503)215-6556		(855)415-6048		(503)215-6556										(800)848-4442		(503)215-6556		(800)848-4442		(503)215-6556																
H3809	002	0	1	20	08	H3809_002_0	1	1						05/26/2022	2023.01	05/26/2022 01:35:44 PM Pacific Daylight Time		05/26/2022 01:28:41 PM Pacific Daylight Time			05/26/2022 01:37:18 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	2023	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	https://www.providence.org/services/pace-and-adult-day-programs/elderplace-in-oregon										(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	5	1			2	0	0	07/12/2022	2023.01	07/12/2022 11:19:31 AM Pacific Daylight Time	06/06/2022 11:06:37 AM Pacific Daylight Time				07/12/2022 11:43:14 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	https://www.allcarehealth.com/medicare/allcare-adv	AllCare Advantage Gold (HMO)	01	01		1			H3810	001	0	2023	Josephine, Jackson, Douglas*		2		2			2									www.AllCareHealth.com/Advantage/Pharmacy	https://www.allcarehealth.com/medicare/allcare-advantage-2021/lookup-tools	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	8	1			1			08/04/2022	2023.01	08/04/2022 10:28:34 AM Pacific Daylight Time	08/04/2022 09:50:28 AM Pacific Daylight Time	08/04/2022 09:50:28 AM Pacific Daylight Time			08/04/2022 10:34:37 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	https://www.allcarehealth.com/medicare/allcare-adv	AllCare Advantage Gold Rx (HMO)	01	01		1			H3810	003	0	2023	Josephine, Jackson, Douglas*		2		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	5	1			2	0	0	07/12/2022	2023.01	07/12/2022 11:21:04 AM Pacific Daylight Time	06/06/2022 11:06:40 AM Pacific Daylight Time				07/12/2022 11:43:14 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	https://www.allcarehealth.com/medicare/allcare-adv	AllCare Advantage Focus (HMO)	01	01		1			H3810	021	0	2023	Josephine, Jackson, Douglas*		2		2			2									www.AllCareHealth.com/Advantage/Pharmacy	https://www.allcarehealth.com/medicare/allcare-advantage-2021/lookup-tools	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	8	1			1			08/04/2022	2023.01	08/04/2022 09:45:26 AM Pacific Daylight Time	08/04/2022 09:50:28 AM Pacific Daylight Time	08/04/2022 09:50:28 AM Pacific Daylight Time			08/04/2022 10:34:37 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	https://www.allcarehealth.com/medicare/allcare-adv	AllCare Advantage Focus Rx (HMO)	01	01		1			H3810	022	0	2023	Josephine, Jackson, Douglas*		2		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	023	0	1	01	01	H3810_023_0	7	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 09:45:44 AM Pacific Daylight Time	08/04/2022 09:50:28 AM Pacific Daylight Time	08/04/2022 09:50:28 AM Pacific Daylight Time			08/04/2022 10:34:37 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	https://www.allcarehealth.com/medicare/allcare-adv	AllCare Advantage Redwood Rx (HMO D-SNP)	01	01		1			H3810	023	0	2023	Josephine, Jackson, Curry, Douglas*		2		2			1	3		2					1	https://www.allcarehealth.com/medicare/allcare-advantage-2023/lookup-tools/find-a-pharmacy	https://www.allcarehealth.com/medicare/allcare-advantage-2023/lookup-tools/formulary-search-preferre	https://www.allcarehealth.com/medicare/allcare-advantage-2023/lookup-tools/find-a-doctor	(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	024	0	1	01	01	H3810_024_0	8	1			1			08/04/2022	2023.01	08/04/2022 09:45:59 AM Pacific Daylight Time	08/04/2022 09:50:29 AM Pacific Daylight Time	08/04/2022 09:50:29 AM Pacific Daylight Time			08/04/2022 10:34:37 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	https://www.allcarehealth.com/medicare/allcare-adv	AllCare Advantage Madrone Rx (HMO)	01	01		1			H3810	024	0	2023	Josephine, Jackson, Curry, Douglas*		2		2			2									https://www.allcarehealth.com/medicare/allcare-advantage-2023/lookup-tools/find-a-pharmacy	https://www.allcarehealth.com/medicare/allcare-advantage-2023/lookup-tools/formulary-search-preferre	https://www.allcarehealth.com/medicare/allcare-advantage-2023/lookup-tools/find-a-doctor	(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	1	1				0	0	05/25/2022	2023.01	05/25/2022 12:40:48 PM Pacific Daylight Time	06/04/2022 07:19:30 AM Pacific Daylight Time				06/04/2022 07:28:11 AM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealthplans.org/shop-samaritan-plans/medica	Samaritan Advantage Conventional Plan (HMO)	01	01		1			H3811	001	0	2023	Benton, Lincoln and Linn counties		2		2			2									https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	(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	2	1						08/04/2022	2023.01	08/04/2022 04:18:36 PM Pacific Daylight Time	08/04/2022 04:27:16 PM Pacific Daylight Time	08/04/2022 04:27:32 PM Pacific Daylight Time			08/04/2022 04:30:11 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealthplans.org/shop-samaritan-plans/medica	Samaritan Advantage Premier Plan (HMO)	01	01		1			H3811	002	0	2023	Benton, Lincoln and Linn counties		2		2			2									www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	(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	6	1	2	1			0	08/04/2022	2023.01	08/04/2022 04:19:17 PM Pacific Daylight Time	08/04/2022 04:27:16 PM Pacific Daylight Time	08/04/2022 04:27:32 PM Pacific Daylight Time			08/04/2022 04:30:11 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealthplans.org/shop-samaritan-plans/medica	Samaritan Advantage Special Needs Plan (HMO D-SNP)	01	01		1			H3811	003	0	2023	Benton, Linn and Lincoln counties		2		2			1	3		2					2	www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	(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	2	1						08/04/2022	2023.01	08/04/2022 04:19:39 PM Pacific Daylight Time	08/04/2022 04:27:16 PM Pacific Daylight Time	08/04/2022 04:27:32 PM Pacific Daylight Time			08/04/2022 04:30:11 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealthplans.org/shop-samaritan-plans/medica	Samaritan Advantage Premier Plan Plus (HMO)	01	01		1			H3811	009	0	2023	Benton, Lincoln, and Linn counties		2		2			2									www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	www.samhealthplans.org/shop-samaritan-plans/medicare-advantage	(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	07/08/2022	2023.01	07/08/2022 01:43:10 PM Pacific Daylight Time	06/06/2022 10:48:38 AM Pacific Daylight Time				07/08/2022 03:35:11 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPO (PPO)	01	04		1			H3813	001	0	2023	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	010	0	1	04	01	H3813_010_0	7	1						08/04/2022	2023.01	08/04/2022 02:07:18 PM Pacific Daylight Time	08/04/2022 01:13:48 PM Pacific Daylight Time	08/02/2022 02:14:12 PM Pacific Daylight Time			08/04/2022 05:19:52 PM 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	2023	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						08/04/2022	2023.01	08/04/2022 02:07:40 PM Pacific Daylight Time	08/04/2022 01:15:28 PM Pacific Daylight Time	08/02/2022 02:15:00 PM Pacific Daylight Time			08/04/2022 05:19:52 PM 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	2023	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						08/04/2022	2023.01	08/04/2022 02:08:00 PM Pacific Daylight Time	08/04/2022 01:16:06 PM Pacific Daylight Time	08/02/2022 02:16:02 PM Pacific Daylight Time			08/04/2022 05:19:52 PM 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	2023	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						08/04/2022	2023.01	08/04/2022 02:08:17 PM Pacific Daylight Time	08/04/2022 01:16:32 PM Pacific Daylight Time	08/02/2022 02:16:48 PM Pacific Daylight Time			08/04/2022 05:19:52 PM 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	2023	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	7	1						08/04/2022	2023.01	08/04/2022 02:08:35 PM Pacific Daylight Time	08/04/2022 01:17:08 PM Pacific Daylight Time	08/02/2022 02:17:38 PM Pacific Daylight Time			08/04/2022 05:19:52 PM 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	2023	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	016	0	1	04	01	H3813_016_0	7	1						08/04/2022	2023.01	08/04/2022 02:08:50 PM Pacific Daylight Time	08/04/2022 01:17:46 PM Pacific Daylight Time	08/02/2022 02:18:24 PM Pacific Daylight Time			08/04/2022 05:19:52 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health + Fred Meyer PPORX (PPO)	01	04		1			H3813	016	0	2023	Metro/NW		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	017	0	1	04	01	H3813_017_0	7	1						08/04/2022	2023.01	08/04/2022 02:09:07 PM Pacific Daylight Time	08/04/2022 01:18:10 PM Pacific Daylight Time	08/02/2022 02:19:14 PM Pacific Daylight Time			08/04/2022 05:19:52 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Value PPORX (PPO)	01	04		1			H3813	017	0	2023	Central/Southern		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	3	1						04/18/2022	2023.01	04/18/2022 03:05:10 PM Pacific Daylight Time					06/03/2022 12:35:26 PM 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	2023	Statewide		1	1200	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;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;11c;15;16b;	2		1									
H3814	007	0	1	01	01	H3814_007_0	5	1	2	1			0	08/04/2022	2023.01	08/04/2022 10:10:42 AM Pacific Daylight Time	08/03/2022 02:40:04 PM Pacific Daylight Time	08/01/2022 10:52:42 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Special Needs Plan (HMO D-SNP)	01	01		1			H3814	007	0	2023	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	9	1			2		0	08/05/2022	2023.01	08/05/2022 12:57:18 PM Pacific Daylight Time	08/05/2022 03:57:12 PM Pacific Daylight Time	08/02/2022 02:20:24 PM Pacific Daylight Time			08/05/2022 01:49:59 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health My Choice (HMO)	01	01		1			H3815	001	0	2023	LA, Orange, San Bernardino & Riverside Counties		2		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	9	1			1		0	08/05/2022	2023.01	08/05/2022 11:34:47 AM Pacific Daylight Time	08/05/2022 12:01:06 PM Pacific Daylight Time	08/02/2022 02:34:36 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health My Choice CalPlus (HMO)	01	01		1			H3815	007	0	2023	SoCal and NorCal		2		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	9	1			2		1	08/05/2022	2023.01	08/05/2022 10:41:14 AM Pacific Daylight Time	08/05/2022 09:57:14 AM Pacific Daylight Time	08/02/2022 02:35:42 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Platinum (HMO)	01	01		1			H3815	008	0	2023	Los Angeles and Orange Counties		2		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	7	1		1	2		1	08/05/2022	2023.01	08/05/2022 10:41:35 AM Pacific Daylight Time	08/05/2022 09:57:08 AM Pacific Daylight Time	08/02/2022 02:25:10 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Heart & Diabetes (HMO C-SNP)	01	01		1			H3815	010	0	2023	SoCal and NorCal		2		2			1	4			00000000000000000010000					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	7	1			2		0	08/05/2022	2023.01	08/05/2022 10:44:07 AM Pacific Daylight Time	08/05/2022 09:57:11 AM Pacific Daylight Time	08/02/2022 02:36:44 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health AllCare Preferred (HMO)	01	01		1			H3815	011	0	2023	Stanislaus County		2		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	7	1			2		0	08/05/2022	2023.01	08/05/2022 11:35:03 AM Pacific Daylight Time	08/05/2022 09:57:03 AM Pacific Daylight Time	08/02/2022 02:37:48 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health smartHMO (HMO)	01	01		1			H3815	013	0	2023	LA, OC, SD, SB, RV		2		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	6	1			2		0	08/05/2022	2023.01	08/05/2022 11:35:31 AM Pacific Daylight Time	08/05/2022 09:57:05 AM Pacific Daylight Time	08/02/2022 02:39:06 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Platinum (HMO)	01	01		1			H3815	015	0	2023	San Bernardino, Riverside		2		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	7	1			2		0	08/05/2022	2023.01	08/05/2022 11:36:52 AM Pacific Daylight Time	08/05/2022 09:57:07 AM Pacific Daylight Time	08/02/2022 02:41:08 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Platinum (HMO)	01	01		1			H3815	016	0	2023	San Diego & Marin		2		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	6	1			2		0	08/05/2022	2023.01	08/05/2022 11:37:13 AM Pacific Daylight Time	08/05/2022 09:56:57 AM Pacific Daylight Time	08/02/2022 02:42:16 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Sutter Advantage (HMO)	01	01		1			H3815	019	0	2023	Sacramento, Placer & Yolo Counties		2		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	6	1			2		0	08/05/2022	2023.01	08/05/2022 11:37:32 AM Pacific Daylight Time	08/05/2022 09:57:00 AM Pacific Daylight Time	08/02/2022 02:43:32 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Sutter Advantage (HMO)	01	01		1			H3815	020	0	2023	Santa Clara County		2		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	7	1			2		0	08/05/2022	2023.01	08/05/2022 11:37:53 AM Pacific Daylight Time	08/05/2022 09:56:54 AM Pacific Daylight Time	08/02/2022 02:45:28 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Sutter Advantage (HMO)	01	01		1			H3815	021	0	2023	Santa Cruz County		2		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	7	1			2		0	08/05/2022	2023.01	08/05/2022 11:38:16 AM Pacific Daylight Time	08/05/2022 09:56:49 AM Pacific Daylight Time	08/02/2022 02:46:30 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Sutter Advantage (HMO)	01	01		1			H3815	023	0	2023	Sonoma, San Mateo, San Francisco Counties		2		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	02	01	H3815_026_0	7	1			2		0	08/05/2022	2023.01	08/05/2022 11:38:42 AM Pacific Daylight Time	08/05/2022 09:56:51 AM Pacific Daylight Time	08/02/2022 02:47:30 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health AVA (HMO-POS)	01	02		1			H3815	026	0	2023	LA, OC, SD, SLO, SC, Stanislaus, Ventura Counties		2		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	5	1			2		0	08/05/2022	2023.01	08/05/2022 11:39:07 AM Pacific Daylight Time	08/05/2022 09:56:53 AM Pacific Daylight Time	08/02/2022 02:48:54 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health My Choice (HMO)	01	01		1			H3815	028	0	2023	San Luis Obispo		2		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	5	1			2		0	08/05/2022	2023.01	08/05/2022 11:39:28 AM Pacific Daylight Time	08/05/2022 09:56:44 AM Pacific Daylight Time	08/02/2022 02:51:04 PM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health My Choice (HMO)	01	01		1			H3815	029	0	2023	Ventura		2		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	6	1	2	1	2		0	07/09/2022	2023.01	07/09/2022 10:31:55 AM Pacific Daylight Time	08/05/2022 09:56:46 AM Pacific Daylight Time	08/02/2022 10:52:22 AM Pacific Daylight Time			08/05/2022 01:33:22 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health CalPlusDuals (HMO D-SNP)	01	01		1			H3815	030	0	2023	Northern and Southern California		2		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	10	1			2		1	08/05/2022	2023.01	08/05/2022 11:39:57 AM Pacific Daylight Time	08/05/2022 05:31:02 PM Pacific Daylight Time	08/02/2022 02:52:10 PM Pacific Daylight Time			08/05/2022 02:36:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Harmony (HMO)	01	01		1			H3815	031	0	2023	AL, LA, OC, SC, SD, SF		2		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	6	1			2		0	08/05/2022	2023.01	08/05/2022 11:40:18 AM Pacific Daylight Time	08/05/2022 09:38:31 AM Pacific Daylight Time	08/02/2022 02:53:22 PM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Select (HMO)	01	01		1			H3815	032	0	2023	San Diego		2		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	8	1		1	2		1	08/22/2022	2023.01	08/22/2022 10:59:28 AM Pacific Daylight Time		08/02/2022 02:31:12 PM Pacific Daylight Time		08/05/2022 09:28:19 AM Pacific Daylight Time	08/22/2022 11:01:19 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health ESRD Balance (HMO C-SNP)	01	01		1			H3815	033	0	2023	Los Angeles and Orange		2		2			1	4			00000000100000000000000					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	6	1			2		0	08/05/2022	2023.01	08/05/2022 11:40:57 AM Pacific Daylight Time	08/05/2022 09:38:33 AM Pacific Daylight Time	08/02/2022 02:56:52 PM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health the ONE + Rite Aid (HMO)	01	01		1			H3815	034	0	2023	LA, OC, SD, SB, SC, Riverside		2		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	035	0	1	01	01	H3815_035_0	6	1			2		0	08/05/2022	2023.01	08/05/2022 11:41:20 AM Pacific Daylight Time	08/05/2022 09:38:35 AM Pacific Daylight Time	08/02/2022 02:58:26 PM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health the ONE (HMO)	01	01		1			H3815	035	0	2023	Fresno, Madera		2		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	036	0	1	01	01	H3815_036_0	7	1			2		0	08/05/2022	2023.01	08/05/2022 11:42:25 AM Pacific Daylight Time	08/05/2022 09:38:26 AM Pacific Daylight Time	08/02/2022 10:44:26 AM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health CalPlus + Veterans (HMO)	01	01		1			H3815	036	0	2023	Northern and Southern California		2		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	037	0	1	01	01	H3815_037_0	7	1			2		0	08/05/2022	2023.01	08/05/2022 11:42:59 AM Pacific Daylight Time	08/05/2022 09:38:26 AM Pacific Daylight Time	08/02/2022 02:59:30 PM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Sutter Advantage (HMO)	01	01		1			H3815	037	0	2023	Alameda		2		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						05/31/2022	2023.01	05/31/2022 05:58:09 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	801	0	2023	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						05/31/2022	2023.01	05/31/2022 05:58:43 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	802	0	2023	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	05/31/2022	2023.01	05/31/2022 05:59:14 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	803	0	2023	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	05/31/2022	2023.01	05/31/2022 06:00:26 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	804	0	2023	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						06/03/2022	2023.01	06/03/2022 12:18:54 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options Complete (HMO)	01	01		1			H3815	805	0	2023	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						06/03/2022	2023.01	06/03/2022 12:19:34 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options Complete (HMO)	01	01		1			H3815	806	0	2023	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	8	1			1		1	08/05/2022	2023.01	08/05/2022 08:40:01 AM Pacific Daylight Time	08/04/2022 02:32:02 PM Pacific Daylight Time	08/01/2022 01:42:50 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark Co, WA	Metro	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H3817	008	2	1	04	01	H3817_008_2	8	1			1		1	08/04/2022	2023.01	08/04/2022 11:12:41 AM Pacific Daylight Time	08/04/2022 02:49:56 PM Pacific Daylight Time	08/01/2022 01:44:06 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark Co, WA	Non-Metro	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H3817	009	1	1	04	01	H3817_009_1	8	1			1		1	08/04/2022	2023.01	08/04/2022 11:14:55 AM Pacific Daylight Time	08/04/2022 02:32:41 PM Pacific Daylight Time	08/01/2022 01:45:29 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark Co, WA	Metro	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H3817	009	2	1	04	01	H3817_009_2	8	1			1		1	07/06/2022	2023.01	07/06/2022 01:53:42 PM Pacific Daylight Time	08/04/2022 02:51:18 PM Pacific Daylight Time	08/01/2022 01:46:37 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark Co, WA	Non-Metro	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H3817	010	0	1	04	01	H3817_010_0	6	1			2	0	0	07/06/2022	2023.01	07/06/2022 01:54:54 PM Pacific Daylight Time	06/01/2022 05:21:38 PM Pacific Daylight Time				07/11/2022 09:05:44 AM 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	2023	Select Counties in Oregon/Clark Co, WA		2		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)-		(800)735-2900		(711)-										2					2						2			
H3817	011	1	1	04	01	H3817_011_1	9	1			1		1	08/04/2022	2023.01	08/04/2022 11:05:47 AM Pacific Daylight Time	08/04/2022 02:33:19 PM Pacific Daylight Time	08/01/2022 01:47:50 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark Co, WA	Metro	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H3817	011	2	1	04	01	H3817_011_2	9	1			1		1	08/04/2022	2023.01	08/04/2022 03:30:10 PM Pacific Daylight Time	08/04/2022 02:53:55 PM Pacific Daylight Time	08/01/2022 01:49:17 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark Co, WA	Non-Metro	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H3817	801	0	1	04	01	H3817_801_0	1	1				0	0	05/06/2022	2023.01	05/06/2022 09:51:07 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	Nationwide except territories		1	15065	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	1	1						05/06/2022	2023.01	05/06/2022 09:51:15 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	Nationwide except territories		1	40519	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	1	1						05/06/2022	2023.01	05/06/2022 09:51:21 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	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	1	1						05/06/2022	2023.01	05/06/2022 09:51:27 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	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	8	1						08/03/2022	2023.01	08/03/2022 12:27:13 PM Central Daylight Time	08/05/2022 02:47:02 PM Central Daylight Time	08/03/2022 05:55:31 PM Central Daylight Time			08/05/2022 07:10:46 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	001	0	2023	Chicago Metro Area		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	002	0	1	01	01	H3822_002_0	7	1						07/02/2022	2023.01	07/02/2022 11:31:32 PM Central Daylight Time	08/05/2022 02:48:14 PM Central Daylight Time	08/03/2022 05:56:52 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getbluenm.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	002	0	2023	Bernalillo, Sandoval, Torrance and Valencia cntys		2		2			2									getbluenm.com/mapd/pharmacies	getbluenm.com/mapd/druglist	getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	007	0	1	02	01	H3822_007_0	8	1						08/03/2022	2023.01	08/03/2022 12:27:43 PM Central Daylight Time	08/05/2022 02:49:23 PM Central Daylight Time	08/03/2022 05:58:12 PM Central Daylight Time			08/05/2022 07:10:46 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Basic Plus (HMO-POS)	01	02		1			H3822	007	0	2023	Chicago Metro Area		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	008	0	1	02	01	H3822_008_0	8	1						08/04/2022	2023.01	08/04/2022 02:41:21 PM Central Daylight Time	08/05/2022 02:50:34 PM Central Daylight Time	08/03/2022 05:59:32 PM Central Daylight Time			08/05/2022 07:10:46 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H3822	008	0	2023	Chicago Metro Area		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	012	0	1	01	01	H3822_012_0	7	1						08/03/2022	2023.01	08/03/2022 12:28:54 PM Central Daylight Time	08/05/2022 02:51:55 PM Central Daylight Time	08/03/2022 06:00:52 PM Central Daylight Time			08/05/2022 07:10:46 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	012	0	2023	Springfield and Central Illinois		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	013	0	1	01	01	H3822_013_0	6	1						08/03/2022	2023.01	08/03/2022 12:29:40 PM Central Daylight Time	08/05/2022 02:54:09 PM Central Daylight Time	08/03/2022 06:02:12 PM Central Daylight Time			08/05/2022 07:10:46 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	013	0	2023	St. Louis and Southern Illinois Counties		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	014	0	1	01	01	H3822_014_0	6	1						08/03/2022	2023.01	08/03/2022 12:30:11 PM Central Daylight Time	08/05/2022 02:55:39 PM Central Daylight Time	08/03/2022 06:03:31 PM Central Daylight Time			08/05/2022 07:10:46 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	014	0	2023	Rockford, Rock Island, and Quincy Metro Markets		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	015	0	1	01	01	H3822_015_0	6	1						08/03/2022	2023.01	08/03/2022 12:30:37 PM Central Daylight Time	08/05/2022 02:56:53 PM Central Daylight Time	08/03/2022 06:04:52 PM Central Daylight Time			08/05/2022 07:10:46 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	015	0	2023	Peoria Metro Market		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	801	0	1	01	01	H3822_801_0	3	1						06/02/2022	2023.01	06/02/2022 12:09:33 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	802	0	1	01	01	H3822_802_0	3	1						06/02/2022	2023.01	06/02/2022 12:08:55 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	Statewide in New Mexico		1	43503	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	805	0	1	01	01	H3822_805_0	3	1						06/02/2022	2023.01	06/02/2022 12:07:56 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	806	0	1	01	01	H3822_806_0	3	1						06/02/2022	2023.01	06/02/2022 12:07:41 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	809	0	1	01	01	H3822_809_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 12:07:18 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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	3	1				0	0	06/02/2022	2023.01	06/02/2022 12:07:02 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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	3	1						06/02/2022	2023.01	06/02/2022 12:06:37 AM Central Daylight Time					06/06/2022 08:35:13 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	813	0	2023	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	814	0	1	01	01	H3822_814_0	3	1						06/02/2022	2023.01	06/02/2022 12:06:23 AM Central Daylight Time					06/06/2022 08:35:13 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	814	0	2023	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	815	0	1	01	01	H3822_815_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 12:06:07 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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			
H3828	001	0	1	04	01	H3828_001_0	5	1					0	08/04/2022	2023.01	08/04/2022 09:27:00 AM Eastern Daylight Time	08/04/2022 05:54:25 PM Eastern Daylight Time	08/04/2022 05:54:25 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Saint Alphonsus Health Plan	www.medigold.com	Saint Alphonsus Health Plan No Premium Choice (PPO)	01	04		1			H3828	001	0	2023	Select Counties in Idaho		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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			
H3828	801	0	1	04	01	H3828_801_0	2	1						05/26/2022	2023.01	05/26/2022 12:17:44 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Saint Alphonsus Health Plan	www.medigold.com	Saint Alphonsus Health Plan Choice EGWP 1 (PPO)	01	04		1			H3828	801	0	2023	Select Counties in Idaho		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H3828	802	0	1	04	01	H3828_802_0	2	1						05/26/2022	2023.01	05/26/2022 12:29:29 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Saint Alphonsus Health Plan	www.medigold.com	Saint Alphonsus Health Plan Choice EGWP 2 (PPO)	01	04		1			H3828	802	0	2023	Select Counties in Idaho		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H3832	007	0	1	04	01	H3832_007_0	6	1			1			08/04/2022	2023.01	08/04/2022 02:17:03 PM Hawaiian Standard Time	08/04/2022 05:08:37 PM Hawaiian Standard Time	08/11/2022 11:17:56 AM Hawaiian Standard Time			08/11/2022 11:23:03 AM 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	2023	Hawaii, Kalawao, Kauai and Maui counties		2		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	6	1			1			08/04/2022	2023.01	08/04/2022 02:18:50 PM Hawaiian Standard Time	08/04/2022 05:08:37 PM Hawaiian Standard Time	08/11/2022 11:17:56 AM Hawaiian Standard Time			08/11/2022 11:25:16 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	2023	Hawaii, Kalawao, Kauai and Maui counties		2		2			2									www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	009	0	1	04	01	H3832_009_0	6	1			1			08/04/2022	2023.01	08/04/2022 02:19:53 PM Hawaiian Standard Time	08/04/2022 05:08:37 PM Hawaiian Standard Time	08/11/2022 11:17:56 AM Hawaiian Standard Time			08/11/2022 11:27:12 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	2023	Honolulu County		2		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			08/04/2022	2023.01	08/04/2022 02:20:25 PM Hawaiian Standard Time	08/04/2022 05:08:38 PM Hawaiian Standard Time	08/11/2022 11:17:56 AM Hawaiian Standard Time			08/11/2022 11:30:23 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	2023	Honolulu County		2		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	6	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 02:20:50 PM Hawaiian Standard Time	08/04/2022 05:08:38 PM Hawaiian Standard Time	08/11/2022 11:17:57 AM Hawaiian Standard Time			08/11/2022 11:32:09 AM 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	2023	Hawaii, Kalawao, Kauai, Maui and Honolulu counties		2		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						08/04/2022	2023.01	08/04/2022 05:04:36 PM Hawaiian Standard Time					08/04/2022 05:32:35 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	2023	National		1	57720	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;6;7b;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						08/04/2022	2023.01	08/04/2022 05:05:18 PM Hawaiian Standard Time					08/04/2022 05:35:43 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	2023	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;6;7b;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	08/04/2022	2023.01	08/04/2022 05:06:42 PM Hawaiian Standard Time					08/04/2022 05:37:29 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	2023	National		1	28244	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;6;7b;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						08/04/2022	2023.01	08/04/2022 05:07:19 PM Hawaiian Standard Time					08/04/2022 05:39:10 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	2023	National		1	63209	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;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;14a;15;	2		1									
H3864	002	0	1	02	01	H3864_002_0	3	1				0	0	07/12/2022	2023.01	07/12/2022 07:55:10 AM Pacific Daylight Time	06/05/2022 06:47:24 PM Pacific Daylight Time				07/12/2022 11:27:47 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Choice 2 (HMO-POS)	01	02		1			H3864	002	0	2023	Select Oregon 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	006	0	1	01	01	H3864_006_0	4	1						06/04/2022	2023.01	06/04/2022 07:43:25 PM Pacific Daylight Time	08/02/2022 11:58:25 AM Pacific Daylight Time	08/02/2022 03:11:16 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Oregon 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		(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	3	1						06/04/2022	2023.01	06/04/2022 07:43:17 PM Pacific Daylight Time	08/02/2022 11:58:53 AM Pacific Daylight Time	08/02/2022 03:11:38 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Oregon 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		(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	024	0	1	02	01	H3864_024_0	3	1						08/02/2022	2023.01	08/02/2022 01:31:53 PM Pacific Daylight Time	08/02/2022 11:59:30 AM Pacific Daylight Time	08/02/2022 03:12:02 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Idaho 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		(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	3	1						08/02/2022	2023.01	08/02/2022 01:55:05 PM Pacific Daylight Time	08/02/2022 11:59:58 AM Pacific Daylight Time	08/02/2022 03:12:26 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Oregon 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		(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	3	1						08/02/2022	2023.01	08/02/2022 01:33:31 PM Pacific Daylight Time	08/02/2022 12:00:45 PM Pacific Daylight Time	08/02/2022 03:12:48 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	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	02	01	H3864_030_0	3	1				0	0	07/12/2022	2023.01	07/12/2022 07:59:09 AM Pacific Daylight Time	06/05/2022 06:50:57 PM Pacific Daylight Time				07/12/2022 11:27:47 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Choice 30 (HMO-POS)	01	02		1			H3864	030	0	2023	Select Idaho, Montana, Oregon, Washington 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	032	0	1	01	01	H3864_032_0	3	1						08/02/2022	2023.01	08/02/2022 01:30:16 PM Pacific Daylight Time	08/02/2022 12:01:18 PM Pacific Daylight Time	08/02/2022 03:13:12 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Idaho 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		(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	034	0	1	02	01	H3864_034_0	3	1						08/02/2022	2023.01	08/02/2022 02:06:01 PM Pacific Daylight Time	08/02/2022 12:01:54 PM Pacific Daylight Time	08/02/2022 03:13:36 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Idaho, Oregon and Washington 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		(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	036	0	1	02	01	H3864_036_0	3	1						08/02/2022	2023.01	08/02/2022 01:09:48 PM Pacific Daylight Time	08/02/2022 12:02:32 PM Pacific Daylight Time	08/02/2022 03:14:00 PM Pacific Daylight Time			08/03/2022 03:44:25 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Choice Rx 36 (HMO-POS)	01	02		1			H3864	036	0	2023	Select Oregon 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	040	0	1	01	01	H3864_040_0	3	1						08/02/2022	2023.01	08/02/2022 01:20:22 PM Pacific Daylight Time	08/02/2022 12:02:57 PM Pacific Daylight Time	08/02/2022 03:14:22 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Oregon and Washington 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		(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	3	1						06/04/2022	2023.01	06/04/2022 07:40:35 PM Pacific Daylight Time	08/02/2022 12:03:30 PM Pacific Daylight Time	08/02/2022 03:14:46 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Oregon 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	02	01	H3864_042_0	3	1						08/02/2022	2023.01	08/02/2022 01:20:54 PM Pacific Daylight Time	08/02/2022 12:03:58 PM Pacific Daylight Time	08/02/2022 03:15:10 PM Pacific Daylight Time			08/03/2022 03:44:25 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Choice Rx 42 (HMO-POS)	01	02		1			H3864	042	0	2023	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	6	1	2	1			0	08/02/2022	2023.01	08/02/2022 01:52:13 PM Pacific Daylight Time	08/02/2022 12:04:24 PM Pacific Daylight Time	08/02/2022 03:15:34 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Oregon Counties		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	06/04/2022	2023.01	06/04/2022 07:40:12 PM Pacific Daylight Time					06/05/2022 08:16:45 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	2023	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						06/04/2022	2023.01	06/04/2022 07:40:06 PM Pacific Daylight Time					06/05/2022 08:16:45 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	2023	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	06/04/2022	2023.01	06/04/2022 07:40:00 PM Pacific Daylight Time					06/05/2022 08:16:45 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	2023	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						06/04/2022	2023.01	06/04/2022 07:39:43 PM Pacific Daylight Time					06/05/2022 08:16:45 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	2023	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	9	1					1	08/04/2022	2023.01	08/04/2022 08:33:56 AM Eastern Daylight Time	08/04/2022 10:27:41 AM Eastern Daylight Time	08/04/2022 10:27:41 AM Eastern Daylight Time			08/04/2022 11:43:17 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins Advantage MD	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD (PPO)	01	04		1			H3890	001	0	2023	Counties: AA BL CR FR HW SS WH WC WR		2		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	10	1					1	08/04/2022	2023.01	08/04/2022 08:34:27 AM Eastern Daylight Time	08/04/2022 10:27:41 AM Eastern Daylight Time	08/04/2022 10:27:42 AM Eastern Daylight Time			08/04/2022 11:44:29 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins Advantage MD	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD Plus (PPO)	01	04		1			H3890	002	0	2023	Counties: AA BL CR FR HW SS WH WC WR		2		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	10	1					1	08/04/2022	2023.01	08/04/2022 11:27:33 AM Eastern Daylight Time	08/04/2022 10:27:42 AM Eastern Daylight Time	08/04/2022 10:27:42 AM Eastern Daylight Time			08/04/2022 11:45:17 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins Advantage MD	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD Premier (PPO)	01	04		1			H3890	004	0	2023	Montgomery County		2		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	005	0	1	04	01	H3890_005_0	10	1					1	08/04/2022	2023.01	08/04/2022 08:35:38 AM Eastern Daylight Time	08/04/2022 10:27:42 AM Eastern Daylight Time	08/04/2022 10:27:42 AM Eastern Daylight Time			08/04/2022 11:46:19 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins Advantage MD	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD Primary (PPO)	01	04		1			H3890	005	0	2023	AA BL FR HW MO		2		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	7	1						06/02/2022	2023.01	06/02/2022 04:40:18 PM Eastern Daylight Time					06/04/2022 09:00:49 PM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins Advantage MD	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan CY (PPO)	01	04		1			H3890	801	0	2023	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)-		2					2						2			
H3907	002	0	1	01	01	H3907_002_0	7	1				0	0	07/13/2022	2023.01	07/13/2022 06:10:27 PM Eastern Daylight Time	06/05/2022 05:47:13 PM Eastern Daylight Time				07/15/2022 04:29:55 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	2023	Western, Central, and North Eastern Pennsylvania		2		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	10	1					1	08/02/2022	2023.01	08/02/2022 08:21:53 AM Eastern Daylight Time	08/05/2022 12:22:45 AM Eastern Daylight Time	08/05/2022 12:23:31 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Western, Central, and North Eastern Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	8	1					1	08/04/2022	2023.01	08/04/2022 09:11:46 PM Eastern Daylight Time	08/05/2022 12:22:45 AM Eastern Daylight Time	08/05/2022 12:23:31 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Western, Central, and North Eastern Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	8	1					1	08/04/2022	2023.01	08/04/2022 09:08:30 PM Eastern Daylight Time	08/05/2022 12:22:49 AM Eastern Daylight Time	08/05/2022 12:23:32 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Western, Central, and North Eastern Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	046	0	1	01	01	H3907_046_0	8	1					1	08/04/2022	2023.01	08/04/2022 08:31:54 PM Eastern Daylight Time	08/05/2022 12:22:49 AM Eastern Daylight Time	08/05/2022 12:23:33 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	South Western and North Central Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	8	1					1	07/13/2022	2023.01	07/13/2022 07:03:29 PM Eastern Daylight Time	08/05/2022 12:22:51 AM Eastern Daylight Time	08/05/2022 12:23:34 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Western, Central, and North Eastern Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	8	1					1	08/04/2022	2023.01	08/04/2022 08:35:22 PM Eastern Daylight Time	08/05/2022 12:22:51 AM Eastern Daylight Time	08/05/2022 12:23:34 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	North Eastern Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	8	1					1	08/04/2022	2023.01	08/04/2022 08:38:08 PM Eastern Daylight Time	08/05/2022 12:22:54 AM Eastern Daylight Time	08/05/2022 12:23:35 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Berks, Cumberland, Dauphin, Lancaster, and York		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	4	1				0	0	06/01/2022	2023.01	06/01/2022 11:31:43 AM Eastern Daylight Time					06/05/2022 06:30:44 PM 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	2023	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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3907	802	0	1	01	01	H3907_802_0	4	1						06/01/2022	2023.01	06/01/2022 11:25:29 AM Eastern Daylight Time					06/05/2022 06:30:44 PM 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	2023	Western Pennsylvania		1	53836	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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3907	803	0	1	01	01	H3907_803_0	4	1						05/31/2022	2023.01	05/31/2022 09:44:22 PM Eastern Daylight Time					06/05/2022 06:30:44 PM 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	2023	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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3908	001	0	1	20	08	H3908_001_0	1	1						06/01/2022	2023.01	06/01/2022 02:46:53 PM Eastern Daylight Time		06/01/2022 01:29:57 PM Eastern Daylight Time			06/01/2022 02:52:01 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	2023	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	3	1						06/01/2022	2023.01	06/01/2022 02:47:59 PM Eastern Daylight Time		06/01/2022 05:42:43 PM Eastern Daylight Time			06/01/2022 05:57:28 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	2023	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	4	1						05/23/2022	2023.01	05/23/2022 09:22:34 AM Eastern Daylight Time	08/04/2022 04:12:33 PM Eastern Daylight Time	08/04/2022 04:25:49 PM Eastern Daylight Time			08/04/2022 05:02:57 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	001	0	2023	Bucks, Philadelphia Counties		2		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	3	1				0	0	05/27/2022	2023.01	05/27/2022 10:45:27 AM Eastern Daylight Time	07/19/2022 09:09:31 AM Eastern Daylight Time				07/19/2022 09:27:57 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Medical Only (PPO)	01	04		1			H3909	007	0	2023	Bucks, Philadelphia Counties		2		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	3	1						05/23/2022	2023.01	05/23/2022 04:53:49 PM Eastern Daylight Time	08/04/2022 04:12:42 PM Eastern Daylight Time	08/04/2022 04:25:58 PM Eastern Daylight Time			08/04/2022 05:02:57 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	009	0	2023	Chester, Delaware, Montgomery Counties		2		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	2			
H3909	014	0	1	04	01	H3909_014_0	3	1						08/02/2022	2023.01	08/02/2022 04:26:11 PM Eastern Daylight Time	08/04/2022 04:12:51 PM Eastern Daylight Time	08/04/2022 04:26:06 PM Eastern Daylight Time			08/04/2022 05:21:27 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	2023	Bucks, Philadelphia Counties		2		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	4	1						08/02/2022	2023.01	08/02/2022 04:57:38 PM Eastern Daylight Time	08/04/2022 04:13:00 PM Eastern Daylight Time	08/04/2022 04:26:14 PM Eastern Daylight Time			08/04/2022 05:21:27 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	2023	Chester, Delaware, Montgomery Counties		2		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						08/02/2022	2023.01	08/02/2022 04:50:53 PM Eastern Daylight Time	08/04/2022 04:13:09 PM Eastern Daylight Time	08/04/2022 04:26:22 PM Eastern Daylight Time			08/04/2022 05:21:27 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	2023	Philadelphia, Bucks, Chester, Delaware, Montgomery		2		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						05/17/2022	2023.01	05/17/2022 02:43:39 PM Eastern Daylight Time	08/04/2022 04:13:18 PM Eastern Daylight Time	08/04/2022 04:26:30 PM Eastern Daylight Time			08/04/2022 05:21:27 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	2023	Philadelphia, Bucks, Chester, Delaware, Montgomery		2		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	05/27/2022	2023.01	05/27/2022 10:55:21 AM Eastern Daylight Time					06/03/2022 07:28:19 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	2023	National		1	7659	2			2									www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)879-4293		(888)879-4293		(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						05/27/2022	2023.01	05/27/2022 11:51:24 AM Eastern Daylight Time					06/03/2022 07:28:19 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	2023	National		1	14709	2			2									www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)879-4293		(888)879-4293		(877)393-6733		(877)393-6733		(888)879-4293		(888)879-4293		(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	7	1						07/21/2022	2023.01	07/21/2022 03:09:23 PM Eastern Daylight Time	08/02/2022 05:26:33 PM Eastern Daylight Time	08/05/2022 11:56:35 AM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	001	0	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:45:59 PM Eastern Daylight Time	08/02/2022 05:27:20 PM Eastern Daylight Time	08/05/2022 11:57:13 AM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	002	0	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:46:53 PM Eastern Daylight Time	08/02/2022 05:31:22 PM Eastern Daylight Time	08/05/2022 11:57:51 AM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Deluxe (PPO)	01	04		1			H3916	005	0	2023	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	07/15/2022	2023.01	07/15/2022 08:47:09 PM Eastern Daylight Time	07/21/2022 04:09:59 PM Eastern Daylight Time				07/26/2022 12:27:44 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Basic (PPO)	01	04		1			H3916	012	0	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:47:34 PM Eastern Daylight Time	08/02/2022 05:33:33 PM Eastern Daylight Time	08/05/2022 11:58:30 AM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Standard (PPO)	01	04		1			H3916	015	0	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:47:58 PM Eastern Daylight Time	08/02/2022 05:34:35 PM Eastern Daylight Time	08/05/2022 11:59:10 AM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	018	0	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:48:19 PM Eastern Daylight Time	08/02/2022 05:41:17 PM Eastern Daylight Time	08/05/2022 11:59:49 AM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Select (PPO)	01	04		1			H3916	022	0	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:48:50 PM Eastern Daylight Time	08/02/2022 05:45:08 PM Eastern Daylight Time	08/05/2022 12:00:28 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Select (PPO)	01	04		1			H3916	024	0	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:49:14 PM Eastern Daylight Time	08/02/2022 05:46:04 PM Eastern Daylight Time	08/05/2022 12:01:07 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	032	0	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:49:35 PM Eastern Daylight Time	08/02/2022 05:46:53 PM Eastern Daylight Time	08/05/2022 12:01:54 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	033	0	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 11:03:39 AM Eastern Daylight Time	08/02/2022 05:47:40 PM Eastern Daylight Time	08/05/2022 12:02:35 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	01	04		1			H3916	034	1	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 11:03:49 AM Eastern Daylight Time	08/02/2022 05:48:29 PM Eastern Daylight Time	08/05/2022 12:03:14 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	01	04		1			H3916	034	3	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 11:04:01 AM Eastern Daylight Time	08/02/2022 05:50:06 PM Eastern Daylight Time	08/05/2022 12:03:53 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	01	04		1			H3916	034	4	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 11:03:08 AM Eastern Daylight Time	08/02/2022 05:51:23 PM Eastern Daylight Time	08/05/2022 12:04:32 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	01	04		1			H3916	034	5	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 11:05:16 AM Eastern Daylight Time	08/02/2022 05:52:24 PM Eastern Daylight Time	08/05/2022 12:05:12 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Distinct (PPO)	01	04		1			H3916	035	1	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 11:05:07 AM Eastern Daylight Time	08/02/2022 05:53:30 PM Eastern Daylight Time	08/05/2022 12:05:52 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Distinct (PPO)	01	04		1			H3916	035	2	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 11:04:59 AM Eastern Daylight Time	08/02/2022 05:55:32 PM Eastern Daylight Time	08/05/2022 12:06:32 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Distinct (PPO)	01	04		1			H3916	035	4	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 11:05:44 AM Eastern Daylight Time	08/02/2022 05:56:33 PM Eastern Daylight Time	08/05/2022 12:07:11 PM Eastern Daylight Time			08/05/2022 02:31:34 PM 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	2023	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	8	1						07/21/2022	2023.01	07/21/2022 03:14:11 PM Eastern Daylight Time	08/02/2022 05:57:31 PM Eastern Daylight Time	08/05/2022 12:07:51 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	037	1	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:54:02 PM Eastern Daylight Time	08/02/2022 05:58:10 PM Eastern Daylight Time	08/05/2022 12:08:30 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	037	2	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:54:26 PM Eastern Daylight Time	08/02/2022 05:58:50 PM Eastern Daylight Time	08/05/2022 12:09:09 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	037	3	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:54:49 PM Eastern Daylight Time	08/02/2022 05:59:30 PM Eastern Daylight Time	08/05/2022 12:09:48 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	037	4	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:55:13 PM Eastern Daylight Time	08/02/2022 06:00:12 PM Eastern Daylight Time	08/05/2022 12:10:27 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Signature (PPO)	01	04		1			H3916	038	0	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:55:40 PM Eastern Daylight Time	08/02/2022 06:00:51 PM Eastern Daylight Time	08/05/2022 12:11:06 PM Eastern Daylight Time			08/05/2022 02:31:34 PM 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	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:56:06 PM Eastern Daylight Time	08/02/2022 06:01:29 PM Eastern Daylight Time	08/05/2022 12:11:44 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Signature (PPO)	01	04		1			H3916	041	1	2023	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	7	1						07/15/2022	2023.01	07/15/2022 08:56:30 PM Eastern Daylight Time	08/02/2022 06:02:06 PM Eastern Daylight Time	08/05/2022 12:12:22 PM Eastern Daylight Time			08/05/2022 02:31:34 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Signature (PPO)	01	04		1			H3916	041	2	2023	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	042	1	1	04	01	H3916_042_1	5	1				0	0	07/15/2022	2023.01	07/15/2022 08:56:56 PM Eastern Daylight Time	07/21/2022 04:36:27 PM Eastern Daylight Time				07/26/2022 12:27:44 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Valor (PPO)	01	04		1			H3916	042	1	2023	WPA	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3916	042	2	1	04	01	H3916_042_2	5	1				0	0	07/15/2022	2023.01	07/15/2022 08:57:20 PM Eastern Daylight Time	07/21/2022 04:36:55 PM Eastern Daylight Time				07/26/2022 12:27:44 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Valor (PPO)	01	04		1			H3916	042	2	2023	WPA	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3916	043	0	1	04	01	H3916_043_0	5	1				0	0	07/15/2022	2023.01	07/15/2022 08:57:46 PM Eastern Daylight Time	07/21/2022 04:37:22 PM Eastern Daylight Time				07/26/2022 12:27:44 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Valor (PPO)	01	04		1			H3916	043	0	2023	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	801	0	1	04	01	H3916_801_0	2	1				0	0	06/02/2022	2023.01	06/02/2022 02:24:57 PM Eastern Daylight Time					06/03/2022 06:01:02 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	2023	Pennsylvania		1	244482	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;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	2	1						06/03/2022	2023.01	06/03/2022 05:48:13 PM Eastern Daylight Time					06/03/2022 06:01:02 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	2023	Pennsylvania		1	635105	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;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	2	1						06/02/2022	2023.01	06/02/2022 01:59:41 PM Eastern Daylight Time					06/03/2022 06:01:02 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	2023	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;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	2	1				0	0	06/02/2022	2023.01	06/02/2022 01:59:52 PM Eastern Daylight Time					06/03/2022 06:01:02 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	2023	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;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	2	1						06/02/2022	2023.01	06/02/2022 02:00:01 PM Eastern Daylight Time					06/03/2022 06:01:02 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	2023	Pennsylvania		1	43464	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;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	2	1						06/02/2022	2023.01	06/02/2022 02:00:11 PM Eastern Daylight Time					06/03/2022 06:01:02 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	2023	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;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	808	0	1	04	01	H3916_808_0	2	1						06/02/2022	2023.01	06/02/2022 02:00:19 PM Eastern Daylight Time					06/03/2022 06:01:02 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD ASO CALENDAR (PPO)	01	04		1			H3916	808	0	2023	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;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	809	0	1	04	01	H3916_809_0	2	1						06/02/2022	2023.01	06/02/2022 02:00:29 PM Eastern Daylight Time					06/03/2022 06:01:02 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO ASO CALENDAR (PPO)	01	04		1			H3916	809	0	2023	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;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	810	0	1	04	01	H3916_810_0	2	1						06/02/2022	2023.01	06/02/2022 01:59:14 PM Eastern Daylight Time					06/03/2022 06:01:02 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare Plus PPO ASO CALENDAR (PPO)	01	04		1			H3916	810	0	2023	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;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	1	1						05/27/2022	2023.01	05/27/2022 09:04:24 AM Eastern Daylight Time		05/26/2022 07:54:02 AM Eastern Daylight Time			05/27/2022 09:10:17 AM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Community LIFE (PACE)	08	20		1			H3917	001	0	2023	Allgny, Wstmld, Washtn - part, Bdfd, Fultn, Somst		2		2			2									www.commlife.org	www.commlife.org										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(711)-		(711)-		(711)-		(711)-																
H3917	002	0	1	20	08	H3917_002_0	1	1						05/27/2022	2023.01	05/27/2022 09:05:04 AM Eastern Daylight Time		05/26/2022 07:54:53 AM Eastern Daylight Time			05/27/2022 09:10:17 AM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Community LIFE (PACE)	08	20		1			H3917	002	0	2023	Allgny, Wstmld, Washtn - part, Bdfd, Fultn, Somst		2		2			2									www.commlife.org	www.commlife.org										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(711)-		(711)-		(711)-		(711)-																
H3918	001	0	1	20	08	H3918_001_0	1	1						05/27/2022	2023.01	05/27/2022 01:26:06 PM Eastern Daylight Time		05/27/2022 01:18:26 PM Eastern Daylight Time			05/27/2022 01:28:44 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	2023	Partial Allegheny*		2		2			2									none	not applicable -- no formulary										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042																
H3918	002	0	1	20	08	H3918_002_0	1	1						05/27/2022	2023.01	05/27/2022 01:26:28 PM Eastern Daylight Time		05/27/2022 01:18:26 PM Eastern Daylight Time			05/27/2022 01:28:44 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	2023	Partial Allegheny *		2		2			2									none	not applicable -- no formulary										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042																
H3919	001	0	1	20	08	H3919_001_0	1	1						05/31/2022	2023.01	05/31/2022 10:19:37 AM Eastern Daylight Time		05/31/2022 10:08:59 AM Eastern Daylight Time			05/31/2022 10:24:11 AM Eastern Daylight Time	Mercy LIFE	Mercy LIFE	trinityhealthpace.org	Mercy LIFE SEPA (PACE)	08	20		1			H3919	001	0	2023	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						05/31/2022	2023.01	05/31/2022 10:19:51 AM Eastern Daylight Time		05/31/2022 10:09:03 AM Eastern Daylight Time			05/31/2022 10:24:11 AM Eastern Daylight Time	Mercy LIFE	Mercy LIFE	trinityhealthpace.org	Mercy LIFE SEPA (PACE)	08	20		1			H3919	002	0	2023	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	3	1					1	07/13/2022	2023.01	07/13/2022 05:33:47 PM Eastern Daylight Time	08/02/2022 02:39:42 PM Eastern Daylight Time	08/04/2022 11:35:48 AM Eastern Daylight Time			08/04/2022 05:16:19 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	BlueJourney Classic (PPO)	01	04		1			H3923	013	0	2023	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	017	0	1	04	01	H3923_017_0	3	1					1	07/13/2022	2023.01	07/13/2022 05:34:09 PM Eastern Daylight Time	08/04/2022 02:00:48 PM Eastern Daylight Time	08/04/2022 11:45:34 AM Eastern Daylight Time			08/04/2022 05:16:19 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	BlueJourney Prime (PPO)	01	04		1			H3923	017	0	2023	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	3	1					1	08/02/2022	2023.01	08/02/2022 08:12:12 PM Eastern Daylight Time	08/02/2022 02:40:36 PM Eastern Daylight Time	08/04/2022 11:47:06 AM Eastern Daylight Time			08/04/2022 05:16:19 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Select (PPO)	01	04		1			H3923	028	0	2023	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	08/02/2022	2023.01	08/02/2022 08:13:26 PM Eastern Daylight Time	08/02/2022 02:41:02 PM Eastern Daylight Time	08/04/2022 11:48:16 AM Eastern Daylight Time			08/04/2022 05:16:19 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Advantage (PPO)	01	04		1			H3923	029	0	2023	7 County South 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	08/02/2022	2023.01	08/02/2022 08:14:49 PM Eastern Daylight Time	08/02/2022 02:41:28 PM Eastern Daylight Time	08/04/2022 11:49:30 AM Eastern Daylight Time			08/04/2022 05:21:29 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health AdvantagePlus (PPO)	01	04		1			H3923	030	0	2023	7 County South 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	031	0	1	04	01	H3923_031_0	3	1					1	08/02/2022	2023.01	08/02/2022 08:07:08 PM Eastern Daylight Time	08/02/2022 02:41:58 PM Eastern Daylight Time	08/04/2022 11:51:34 AM Eastern Daylight Time			08/04/2022 05:21:29 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Value (PPO)	01	04		1			H3923	031	0	2023	7 County South 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	032	0	1	04	01	H3923_032_0	3	1					1	08/02/2022	2023.01	08/02/2022 08:08:23 PM Eastern Daylight Time	08/02/2022 02:42:28 PM Eastern Daylight Time	08/04/2022 11:52:50 AM Eastern Daylight Time			08/04/2022 05:21:29 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Value (PPO)	01	04		1			H3923	032	0	2023	Lehigh Valley Region		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	033	0	1	04	01	H3923_033_0	4	1					1	08/02/2022	2023.01	08/02/2022 08:09:55 PM Eastern Daylight Time	08/02/2022 02:43:00 PM Eastern Daylight Time	08/04/2022 11:54:04 AM Eastern Daylight Time			08/04/2022 05:21:29 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Value (PPO)	01	04		1			H3923	033	0	2023	Central Region		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	034	0	1	04	01	H3923_034_0	3	1					1	08/02/2022	2023.01	08/02/2022 08:15:49 PM Eastern Daylight Time	08/04/2022 02:01:12 PM Eastern Daylight Time	08/04/2022 11:55:12 AM Eastern Daylight Time			08/04/2022 05:25:10 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Enhanced (PPO)	01	04		1			H3923	034	0	2023	Lehigh Valley Region		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	035	0	1	04	01	H3923_035_0	3	1					1	08/02/2022	2023.01	08/02/2022 08:16:57 PM Eastern Daylight Time	08/02/2022 02:44:10 PM Eastern Daylight Time	08/04/2022 11:56:26 AM Eastern Daylight Time			08/04/2022 05:25:10 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Enhanced (PPO)	01	04		1			H3923	035	0	2023	Central Region		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	036	0	1	04	01	H3923_036_0	4	1					1	08/02/2022	2023.01	08/02/2022 08:10:59 PM Eastern Daylight Time	08/02/2022 02:44:42 PM Eastern Daylight Time	08/04/2022 11:57:34 AM Eastern Daylight Time			08/04/2022 05:25:10 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Value (PPO)	01	04		1			H3923	036	0	2023	Berks County		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	037	0	1	04	01	H3923_037_0	3	1					1	08/02/2022	2023.01	08/02/2022 08:18:05 PM Eastern Daylight Time	08/04/2022 02:01:36 PM Eastern Daylight Time	08/04/2022 11:58:48 AM Eastern Daylight Time			08/04/2022 05:25:10 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Enhanced (PPO)	01	04		1			H3923	037	0	2023	Berks County		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	2	1						06/01/2022	2023.01	06/01/2022 04:21:04 PM Eastern Daylight Time					06/04/2022 04:33:38 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group Rx (CY) (PPO)	01	04		1			H3923	801	0	2023	National		1	14412	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	06/01/2022	2023.01	06/01/2022 04:22:34 PM Eastern Daylight Time					06/04/2022 04:33:38 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group No Rx (CY) (PPO)	01	04		1			H3923	802	0	2023	National		1	14412	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	817	0	1	04	01	H3923_817_0	1	1						06/01/2022	2023.01	06/01/2022 04:23:45 PM Eastern Daylight Time					06/04/2022 04:33:38 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group Custom Rx (CY) (PPO)	01	04		1			H3923	817	0	2023	National		1	14412	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						06/01/2022	2023.01	06/01/2022 04:24:57 PM Eastern Daylight Time					06/04/2022 04:33:38 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group Rx Complete (CY) (PPO)	01	04		1			H3923	818	0	2023	National		1	14412	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						06/01/2022	2023.01	06/01/2022 04:30:04 PM Eastern Daylight Time					06/04/2022 04:33:38 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group Rx Standard (CY) (PPO)	01	04		1			H3923	819	0	2023	National		1	14412	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						06/01/2022	2023.01	06/01/2022 04:35:02 PM Eastern Daylight Time					06/04/2022 04:33:38 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group Rx (FY) (PPO)	01	04		1			H3923	820	0	2023	National		1	14412	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	832	0	1	04	01	H3923_832_0	1	1				0	0	06/01/2022	2023.01	06/01/2022 04:40:36 PM Eastern Daylight Time					06/04/2022 04:33:38 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group No Rx (FY) (PPO)	01	04		1			H3923	832	0	2023	National		1	14412	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									
H3924	059	21	1	04	01	H3924_059_21	5	1					1	06/29/2022	2023.01	06/29/2022 05:35:54 PM Eastern Daylight Time	08/04/2022 01:27:08 PM Eastern Daylight Time	08/03/2022 01:02:00 PM Eastern Daylight Time			08/05/2022 06:27:36 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	2023	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	06/29/2022	2023.01	06/29/2022 05:37:21 PM Eastern Daylight Time	08/04/2022 01:30:12 PM Eastern Daylight Time	08/03/2022 01:03:08 PM Eastern Daylight Time			08/05/2022 06:27:36 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	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 10:11:38 AM Eastern Daylight Time	08/04/2022 01:33:14 PM Eastern Daylight Time	08/03/2022 01:04:16 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	21	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 10:08:01 AM Eastern Daylight Time	08/04/2022 01:36:26 PM Eastern Daylight Time	08/03/2022 01:05:22 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	22	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 10:13:42 AM Eastern Daylight Time	08/04/2022 02:10:56 PM Eastern Daylight Time	08/03/2022 01:06:30 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	23	2023	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	08/04/2022	2023.01	08/04/2022 10:22:41 AM Eastern Daylight Time	08/04/2022 01:40:26 PM Eastern Daylight Time	08/03/2022 01:07:38 PM Eastern Daylight Time			08/05/2022 06:27:36 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	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 10:25:44 AM Eastern Daylight Time	08/04/2022 01:43:14 PM Eastern Daylight Time	08/03/2022 01:08:46 PM Eastern Daylight Time			08/05/2022 06:27:36 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	2023	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						05/24/2022	2023.01	05/24/2022 11:59:05 AM Eastern Daylight Time					06/03/2022 05:40:15 PM 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	2023	Pennsylvania		1	600	2			2									www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3925	001	0	1	20	08	H3925_001_0	1	1						05/26/2022	2023.01	05/26/2022 10:32:49 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown	www.seniorlifepa.com	Senior LIFE Johnstown Dual Eligible (PACE)	08	20		1			H3925	001	0	2023	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	1	1						05/26/2022	2023.01	05/26/2022 10:32:56 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown	www.seniorlifejohnstown.com	Senior LIFE Johnstown Medicare Only (PACE)	08	20		1			H3925	002	0	2023	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	7	1					1	08/10/2022	2023.01	08/10/2022 03:18:08 PM Eastern Daylight Time	08/03/2022 12:59:49 PM Eastern Daylight Time	07/31/2022 10:32:30 PM Eastern Daylight Time			08/10/2022 03:26:45 PM Eastern Daylight Time	AETNA HEALTH INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Plan (HMO)	01	01		1			H3928	001	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 09:30:10 PM Eastern Daylight Time	08/03/2022 01:01:01 PM Eastern Daylight Time	07/31/2022 10:32:56 PM Eastern Daylight Time			08/04/2022 05:34:59 PM Eastern Daylight Time	AETNA HEALTH INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Plan (HMO)	01	01		1			H3928	002	0	2023	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						05/30/2022	2023.01	05/30/2022 09:38:13 AM Eastern Daylight Time					06/02/2022 03:17:02 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	2023	Louisiana		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3928	803	0	1	01	01	H3928_803_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 09:36:19 AM Eastern Daylight Time					06/02/2022 03:17:02 PM Eastern Daylight Time	AETNA HEALTH INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3928	803	0	2023	Louisiana		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3931	004	0	1	02	01	H3931_004_0	2	1			1		0	05/31/2022	2023.01	05/31/2022 12:03:20 PM Eastern Daylight Time	08/03/2022 12:32:30 PM Eastern Daylight Time	07/31/2022 10:33:24 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO-POS)	01	02		1			H3931	004	0	2023	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			
H3931	064	0	1	02	01	H3931_064_0	3	1			2		0	07/15/2022	2023.01	07/15/2022 01:43:27 PM Eastern Daylight Time	08/03/2022 12:33:48 PM Eastern Daylight Time	07/31/2022 10:33:52 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H3931	064	0	2023	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			
H3931	070	0	1	01	01	H3931_070_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 12:06:55 PM Eastern Daylight Time	08/03/2022 12:35:13 PM Eastern Daylight Time	07/31/2022 10:34:18 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Silver (HMO)	01	01		1			H3931	070	0	2023	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	08/02/2022	2023.01	08/02/2022 11:57:23 AM Eastern Daylight Time	08/03/2022 12:36:34 PM Eastern Daylight Time	07/31/2022 10:34:42 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PinnacleHealth Prime (HMO)	01	01		1			H3931	091	0	2023	South 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	092	0	1	02	01	H3931_092_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:44:03 PM Eastern Daylight Time	08/02/2022 02:02:57 PM Eastern Daylight Time	07/31/2022 10:35:08 PM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO-POS)	01	02		1			H3931	092	0	2023	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	094	0	1	02	01	H3931_094_0	4	1			2		0	08/02/2022	2023.01	08/02/2022 05:40:26 PM Eastern Daylight Time	08/02/2022 02:35:38 PM Eastern Daylight Time	07/31/2022 10:35:34 PM Eastern Daylight Time			08/04/2022 06:12:59 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	2023	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			
H3931	095	0	1	02	01	H3931_095_0	5	1			2		0	05/31/2022	2023.01	05/31/2022 08:03:54 PM Eastern Daylight Time	08/02/2022 01:12:05 PM Eastern Daylight Time	07/31/2022 10:36:00 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO-POS)	01	02		1			H3931	095	0	2023	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	05/31/2022	2023.01	05/31/2022 05:53:15 PM Eastern Daylight Time	08/02/2022 01:01:18 PM Eastern Daylight Time	07/31/2022 10:36:28 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO-POS)	01	02		1			H3931	096	0	2023	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	5	1			2		0	05/31/2022	2023.01	05/31/2022 07:08:56 PM Eastern Daylight Time	08/02/2022 01:03:08 PM Eastern Daylight Time	07/31/2022 10:36:52 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Connect Plus (HMO)	01	01		1			H3931	097	0	2023	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	5	1			2		0	08/02/2022	2023.01	08/02/2022 02:55:50 PM Eastern Daylight Time	08/02/2022 01:05:12 PM Eastern Daylight Time	07/31/2022 10:37:18 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	098	0	2023	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	4	1			1		0	08/02/2022	2023.01	08/02/2022 03:10:32 PM Eastern Daylight Time	08/02/2022 01:07:12 PM Eastern Daylight Time	07/31/2022 10:37:44 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	099	0	2023	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	4	1			2		0	08/02/2022	2023.01	08/02/2022 03:14:55 PM Eastern Daylight Time	08/02/2022 01:09:23 PM Eastern Daylight Time	07/31/2022 10:38:10 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	100	0	2023	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	4	1			2		0	08/02/2022	2023.01	08/02/2022 03:16:00 PM Eastern Daylight Time	08/02/2022 01:15:44 PM Eastern Daylight Time	07/31/2022 10:38:36 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	101	0	2023	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	05/31/2022	2023.01	05/31/2022 12:14:11 PM Eastern Daylight Time	08/03/2022 12:37:48 PM Eastern Daylight Time	07/31/2022 10:39:02 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO)	01	01		1			H3931	102	0	2023	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	02	01	H3931_104_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:29:14 PM Eastern Daylight Time	08/03/2022 12:39:00 PM Eastern Daylight Time	07/31/2022 10:39:28 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (HMO-POS)	01	02		1			H3931	104	0	2023	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	02	01	H3931_105_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:30:52 PM Eastern Daylight Time	08/03/2022 12:40:10 PM Eastern Daylight Time	07/31/2022 10:39:54 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Philly Suburban Value (HMO-POS)	01	02		1			H3931	105	0	2023	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			
H3931	107	0	1	02	01	H3931_107_0	4	1			2		0	08/02/2022	2023.01	08/02/2022 04:55:47 PM Eastern Daylight Time	08/03/2022 08:36:33 AM Eastern Daylight Time	07/31/2022 10:40:18 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3931	107	0	2023	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	4	1			2		0	08/02/2022	2023.01	08/02/2022 04:56:51 PM Eastern Daylight Time	08/03/2022 08:37:29 AM Eastern Daylight Time	07/31/2022 10:40:44 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	108	0	2023	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			
H3931	109	0	1	02	01	H3931_109_0	4	1			2		0	08/02/2022	2023.01	08/02/2022 04:57:36 PM Eastern Daylight Time	08/03/2022 08:38:24 AM Eastern Daylight Time	07/31/2022 10:41:10 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (HMO-POS)	01	02		1			H3931	109	0	2023	Toledo and Cincinnati 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	115	0	1	02	01	H3931_115_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 05:41:05 PM Eastern Daylight Time	08/02/2022 02:36:39 PM Eastern Daylight Time	07/31/2022 10:41:36 PM Eastern Daylight Time			08/04/2022 06:12:59 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	2023	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			
H3931	124	0	1	02	01	H3931_124_0	5	1			2		0	05/31/2022	2023.01	05/31/2022 07:31:21 PM Eastern Daylight Time	08/02/2022 01:18:11 PM Eastern Daylight Time	07/31/2022 10:42:02 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern 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	2023	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	3	1			2		0	08/10/2022	2023.01	08/10/2022 03:06:11 PM Eastern Daylight Time	08/02/2022 03:25:28 PM Eastern Daylight Time	07/31/2022 10:42:28 PM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	08/02/2022	2023.01	08/02/2022 01:44:51 PM Eastern Daylight Time	08/02/2022 02:03:54 PM Eastern Daylight Time	07/31/2022 10:42:54 PM Eastern Daylight Time			08/04/2022 05:35:21 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	2023	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	143	0	1	02	01	H3931_143_0	4	1			2		0	08/02/2022	2023.01	08/02/2022 03:21:31 PM Eastern Daylight Time	08/02/2022 01:19:31 PM Eastern Daylight Time	07/31/2022 10:43:18 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	143	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	145	0	1	02	01	H3931_145_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:44:37 PM Eastern Daylight Time	08/02/2022 02:04:49 PM Eastern Daylight Time	07/31/2022 10:43:44 PM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Sunrise Plan (HMO-POS)	01	02		1			H3931	145	0	2023	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			
H3931	146	0	1	02	01	H3931_146_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:45:08 PM Eastern Daylight Time	08/02/2022 02:05:43 PM Eastern Daylight Time	07/31/2022 10:44:10 PM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Sunrise Plan (HMO-POS)	01	02		1			H3931	146	0	2023	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			
H3931	147	0	1	02	01	H3931_147_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:45:24 PM Eastern Daylight Time	08/02/2022 02:06:40 PM Eastern Daylight Time	07/31/2022 10:44:36 PM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Sunrise Plan (HMO-POS)	01	02		1			H3931	147	0	2023	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			
H3931	148	0	1	02	01	H3931_148_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:45:43 PM Eastern Daylight Time	08/02/2022 02:07:38 PM Eastern Daylight Time	07/31/2022 10:45:02 PM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Sunrise Plan (HMO-POS)	01	02		1			H3931	148	0	2023	Cochise, Gila, Graham and Santa Cruz 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	149	0	1	02	01	H3931_149_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 05:42:29 PM Eastern Daylight Time	08/02/2022 03:26:31 PM Eastern Daylight Time	07/31/2022 10:45:36 PM Eastern Daylight Time			08/04/2022 06:12:59 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (HMO-POS)	01	02		1			H3931	149	0	2023	Tri-Cities, Walla Walla and Yakima 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	151	0	1	02	01	H3931_151_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 05:43:14 PM Eastern Daylight Time	08/02/2022 02:37:41 PM Eastern Daylight Time	07/31/2022 10:46:02 PM Eastern Daylight Time			08/04/2022 06:12:59 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plus Plan (HMO-POS)	01	02		1			H3931	151	0	2023	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			
H3931	152	0	1	02	01	H3931_152_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 05:43:43 PM Eastern Daylight Time	08/02/2022 02:38:43 PM Eastern Daylight Time	07/31/2022 10:46:48 PM Eastern Daylight Time			08/04/2022 06:12:59 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3931	152	0	2023	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			
H3931	153	0	1	02	01	H3931_153_0	5	1			2		0	08/01/2022	2023.01	08/01/2022 01:04:10 PM Central Daylight Time	08/02/2022 12:51:51 PM Central Daylight Time	07/31/2022 09:47:16 PM Central Daylight Time			08/04/2022 09:48:52 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 1 (HMO-POS)	01	02		1			H3931	153	0	2023	Denver Metro & Northern Colorado		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	154	0	1	02	01	H3931_154_0	2	1						08/01/2022	2023.01	08/01/2022 01:04:31 PM Central Daylight Time	08/02/2022 12:52:41 PM Central Daylight Time	07/31/2022 09:47:50 PM Central Daylight Time			08/04/2022 09:48:52 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 2 (HMO-POS)	01	02		1			H3931	154	0	2023	Southern & Western Colorado		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	801	0	1	01	01	H3931_801_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 09:33:00 AM Eastern Daylight Time					06/02/2022 03:18:42 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3931	801	0	2023	Pennsylvania		1	19460	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3931	804	0	1	01	01	H3931_804_0	1	1						05/30/2022	2023.01	05/30/2022 09:35:19 AM Eastern Daylight Time					06/02/2022 03:18:42 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	2023	Pennsylvania		1	23780	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3942	001	0	1	20	08	H3942_001_0	1	1						05/25/2022	2023.01	05/25/2022 11:08:07 AM Eastern Daylight Time		05/24/2022 07:40:26 PM Eastern Daylight Time			05/30/2022 10:47:55 AM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	001	0	2023	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						05/25/2022	2023.01	05/25/2022 11:08:37 AM Eastern Daylight Time		05/24/2022 07:41:58 PM Eastern Daylight Time			05/30/2022 10:47:55 AM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	002	0	2023	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	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 07:14:03 PM Central Daylight Time	08/02/2022 01:29:04 PM Central Daylight Time	08/01/2022 10:32:53 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H3949	009	0	2023	Pennsylvania		2		2			1	3		1					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			
H3949	013	0	1	01	01	H3949_013_0	4	1			2		1	06/01/2022	2023.01	06/01/2022 07:13:50 PM Central Daylight Time	08/02/2022 01:29:57 PM Central Daylight Time	08/01/2022 10:33:24 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H3949	013	0	2023	Philadelphia		2		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			
H3949	024	0	1	01	01	H3949_024_0	4	1		1				08/02/2022	2023.01	08/02/2022 07:34:08 PM Central Daylight Time	08/02/2022 01:31:26 PM Central Daylight Time	08/01/2022 10:33:55 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Achieve Medicare (HMO C-SNP)	01	01		1			H3949	024	0	2023	Philadelphia		2		2			1	4			00000010000000000000000					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			
H3949	026	0	1	01	01	H3949_026_0	2	1				0	0	06/01/2022	2023.01	06/01/2022 07:13:26 PM Central Daylight Time	05/30/2022 01:35:40 PM Central Daylight Time				06/02/2022 08:07:39 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H3949	026	0	2023	Philadelphia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3949	030	0	1	01	01	H3949_030_0	4	1			2		1	06/01/2022	2023.01	06/01/2022 07:13:07 PM Central Daylight Time	08/02/2022 01:33:03 PM Central Daylight Time	08/01/2022 10:34:26 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	030	0	2023	Philadelphia		2		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			
H3949	031	0	1	01	01	H3949_031_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:34:37 PM Central Daylight Time	08/02/2022 01:33:45 PM Central Daylight Time	08/01/2022 10:34:57 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Alliance Medicare (HMO)	01	01		1			H3949	031	0	2023	Philadelphia		2		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			
H3949	032	0	1	01	01	H3949_032_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:35:05 PM Central Daylight Time	08/02/2022 01:34:51 PM Central Daylight Time	08/01/2022 10:35:28 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	032	0	2023	Southern New Jersey		2		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			
H3949	034	0	1	01	01	H3949_034_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:35:31 PM Central Daylight Time	08/02/2022 01:36:18 PM Central Daylight Time	08/01/2022 10:35:59 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	034	0	2023	Central New Jersey		2		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			
H3949	035	0	1	01	01	H3949_035_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:35:54 PM Central Daylight Time	08/02/2022 01:37:08 PM Central Daylight Time	08/01/2022 10:36:31 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	035	0	2023	Central Pennsylvania		2		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			
H3949	045	0	1	01	01	H3949_045_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:36:27 PM Central Daylight Time	08/02/2022 01:37:56 PM Central Daylight Time	08/01/2022 10:37:02 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	045	0	2023	Central Pennsylvania		2		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			
H3949	046	0	1	01	01	H3949_046_0	4	1			2		1	06/01/2022	2023.01	06/01/2022 07:11:46 PM Central Daylight Time	08/02/2022 01:38:40 PM Central Daylight Time	08/01/2022 10:37:33 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H3949	046	0	2023	Central Pennsylvania		2		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			
H3949	047	0	1	01	01	H3949_047_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:37:31 PM Central Daylight Time	08/02/2022 01:39:21 PM Central Daylight Time	08/01/2022 10:38:04 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	047	0	2023	Western Pennsylvania		2		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			
H3949	048	0	1	01	01	H3949_048_0	4	1			2		1	06/01/2022	2023.01	06/01/2022 07:11:21 PM Central Daylight Time	08/02/2022 01:40:21 PM Central Daylight Time	08/01/2022 10:38:35 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H3949	048	0	2023	Western Pennsylvania		2		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			
H3949	049	0	1	01	01	H3949_049_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:37:56 PM Central Daylight Time	08/02/2022 01:41:02 PM Central Daylight Time	08/01/2022 10:39:06 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	049	0	2023	Northwest Pennsylvania		2		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			
H3949	050	0	1	01	01	H3949_050_0	4	1			2		1	06/01/2022	2023.01	06/01/2022 07:10:54 PM Central Daylight Time	08/02/2022 01:41:46 PM Central Daylight Time	08/01/2022 10:39:37 AM Central Daylight Time			08/04/2022 01:55:36 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H3949	050	0	2023	Northwest Pennsylvania		2		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			
H3949	051	0	1	01	01	H3949_051_0	2	1			2	0	0	06/01/2022	2023.01	06/01/2022 07:10:48 PM Central Daylight Time	05/30/2022 01:44:03 PM Central Daylight Time				06/02/2022 08:07:39 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H3949	051	0	2023	Southern New Jersey		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3949	804	0	1	01	01	H3949_804_0	3	1						06/15/2022	2023.01	06/15/2022 04:07:51 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	804	0	2023	Statewide NJ & PA		1	1140	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	3	1				0	0	06/02/2022	2023.01	06/02/2022 01:11:12 PM Eastern Daylight Time	07/19/2022 09:09:41 AM Eastern Daylight Time				07/19/2022 10:27:49 AM 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	2023	Bucks, Philadelphia Counties		2		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	06/02/2022	2023.01	06/02/2022 01:15:08 PM Eastern Daylight Time	08/04/2022 04:13:27 PM Eastern Daylight Time	08/04/2022 04:26:38 PM Eastern Daylight Time			08/04/2022 05:44:35 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	2023	Bucks, Philadelphia Counties		2		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	3	1				0	0	06/02/2022	2023.01	06/02/2022 01:20:28 PM Eastern Daylight Time	07/19/2022 09:09:03 AM Eastern Daylight Time				07/19/2022 10:27:49 AM 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	2023	Chester, Delaware, Montgomery Counties		2		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	4	1					1	06/02/2022	2023.01	06/02/2022 01:24:38 PM Eastern Daylight Time	08/04/2022 04:13:36 PM Eastern Daylight Time	08/04/2022 04:26:46 PM Eastern Daylight Time			08/04/2022 05:44:35 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	2023	Chester, Delaware, Montgomery Counties		2		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	2	1				0	0	05/18/2022	2023.01	05/18/2022 03:01:19 PM Eastern Daylight Time	06/06/2022 01:08:11 PM Eastern Daylight Time				06/06/2022 03:11:37 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	2023	Bucks, Philadelphia Counties		2		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	4	1					1	05/18/2022	2023.01	05/18/2022 02:12:05 PM Eastern Daylight Time	08/04/2022 04:13:44 PM Eastern Daylight Time	08/04/2022 04:26:54 PM Eastern Daylight Time			08/04/2022 05:44:35 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	2023	Bucks, Philadelphia Counties		2		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	05/18/2022	2023.01	05/18/2022 02:50:59 PM Eastern Daylight Time	06/06/2022 01:08:37 PM Eastern Daylight Time				06/06/2022 03:24:47 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	2023	Chester, Delaware, Montgomery Counties		2		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	3	1					1	05/18/2022	2023.01	05/18/2022 02:55:26 PM Eastern Daylight Time	08/04/2022 04:13:53 PM Eastern Daylight Time	08/04/2022 04:27:02 PM Eastern Daylight Time			08/04/2022 05:44:35 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	2023	Chester, Delaware, Montgomery Counties		2		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	08/02/2022	2023.01	08/02/2022 03:53:30 PM Eastern Daylight Time	08/04/2022 04:14:02 PM Eastern Daylight Time	08/04/2022 04:25:18 PM Eastern Daylight Time			08/04/2022 06:24:09 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	2023	Philadelphia, Bucks		2		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	3	1					1	08/04/2022	2023.01	08/04/2022 06:05:10 PM Eastern Daylight Time	08/04/2022 04:12:05 PM Eastern Daylight Time	08/04/2022 04:25:26 PM Eastern Daylight Time			08/04/2022 06:24:09 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	2023	Chester, Delaware, Montgomery		2		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	4	1						08/02/2022	2023.01	08/02/2022 03:26:39 PM Eastern Daylight Time	08/04/2022 04:12:14 PM Eastern Daylight Time	08/04/2022 04:25:34 PM Eastern Daylight Time			08/04/2022 06:24:09 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	2023	Philadelphia, Bucks		2		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						08/04/2022	2023.01	08/04/2022 06:01:03 PM Eastern Daylight Time	08/04/2022 04:12:23 PM Eastern Daylight Time	08/04/2022 04:25:42 PM Eastern Daylight Time			08/04/2022 06:24:09 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	2023	Chester, Delaware, Montgomery		2		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	059	0	1	01	01	H3952_059_0	3	1				0	0	05/18/2022	2023.01	05/18/2022 02:30:44 PM Eastern Daylight Time	06/06/2022 01:10:12 PM Eastern Daylight Time				06/06/2022 04:00:29 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Liberty Medical Only (HMO)	01	01		1			H3952	059	0	2023	Philadelphia, Bucks, Chester, Delaware, Montgomery		2		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	802	0	1	01	01	H3952_802_0	1	1				0	0	05/27/2022	2023.01	05/27/2022 11:32:41 AM Eastern Daylight Time					06/03/2022 09:18:28 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	2023	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	10996	2			2									www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(844)352-1699		(844)352-1699		(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						05/27/2022	2023.01	05/27/2022 11:37:58 AM Eastern Daylight Time					06/03/2022 09:18:28 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	2023	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	21503	2			2									www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(844)352-1699		(844)352-1699		(877)393-6733		(877)393-6733		(844)352-1699		(844)352-1699		(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	4	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 05:14:06 PM Eastern Daylight Time	08/04/2022 01:47:16 PM Eastern Daylight Time	08/03/2022 01:09:52 PM Eastern Daylight Time			08/05/2022 06:27:36 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	2023	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	157	21	1	01	01	H3954_157_21	5	1			2		1	08/04/2022	2023.01	08/05/2022 05:51:34 PM Eastern Daylight Time	08/04/2022 01:50:10 PM Eastern Daylight Time	08/03/2022 01:11:00 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	21	2023	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	08/04/2022	2023.01	08/04/2022 05:16:15 PM Eastern Daylight Time	08/04/2022 01:53:14 PM Eastern Daylight Time	08/03/2022 01:12:08 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	22	2023	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	08/04/2022	2023.01	08/05/2022 05:51:35 PM Eastern Daylight Time	08/04/2022 01:56:26 PM Eastern Daylight Time	08/03/2022 01:13:16 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	23	2023	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	4	1			2		1	08/04/2022	2023.01	08/05/2022 06:07:21 PM Eastern Daylight Time	08/04/2022 02:14:28 PM Eastern Daylight Time	08/03/2022 01:14:24 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	13	2023	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	4	1			2		1	08/04/2022	2023.01	08/04/2022 05:18:27 PM Eastern Daylight Time	08/04/2022 02:17:20 PM Eastern Daylight Time	08/03/2022 01:15:32 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	14	2023	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	4	1			2		1	08/04/2022	2023.01	08/04/2022 05:19:21 PM Eastern Daylight Time	08/04/2022 02:00:26 PM Eastern Daylight Time	08/03/2022 01:16:38 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic 360 Rx (HMO)	01	01		1			H3954	160	0	2023	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	4	1			2		1	08/04/2022	2023.01	08/04/2022 01:01:48 PM Eastern Daylight Time	08/04/2022 02:04:02 PM Eastern Daylight Time	08/03/2022 01:17:48 PM Eastern Daylight Time			08/05/2022 06:27:36 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	161	0	2023	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	162	0	1	01	01	H3954_162_0	3	1			2	0	0	05/31/2022	2023.01	05/31/2022 04:56:39 PM Eastern Daylight Time	06/03/2022 04:22:08 PM Eastern Daylight Time				06/03/2022 05:40:15 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Heritage (HMO)	01	01		1			H3954	162	0	2023	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	801	0	1	01	01	H3954_801_0	3	1				0	0	05/19/2022	2023.01	05/19/2022 09:57:19 AM Eastern Daylight Time					06/03/2022 05:40:15 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic (Employer Group) (HMO)	01	01		1			H3954	801	0	2023	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						05/19/2022	2023.01	05/19/2022 10:00:50 AM Eastern Daylight Time					06/03/2022 05:40:15 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Rx (Employer Group) (HMO)	01	01		1			H3954	802	0	2023	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						05/19/2022	2023.01	05/19/2022 10:01:25 AM Eastern Daylight Time					06/03/2022 05:40:15 PM 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	2023	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	12	1			1		0	07/18/2022	2023.01	07/18/2022 08:26:21 AM Eastern Daylight Time	08/02/2022 09:34:12 PM Eastern Daylight Time	08/05/2022 12:13:01 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS ValueRx (HMO-POS)	01	02		1			H3957	031	0	2023	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	10	1			2		1	08/04/2022	2023.01	08/04/2022 11:56:29 AM Eastern Daylight Time	08/02/2022 09:35:19 PM Eastern Daylight Time	08/05/2022 12:13:39 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Prestige (HMO)	01	01		1			H3957	039	0	2023	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	10	1			2		1	07/18/2022	2023.01	07/18/2022 08:25:51 AM Eastern Daylight Time	08/02/2022 09:36:41 PM Eastern Daylight Time	08/05/2022 12:14:18 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	1	2023	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	10	1			2		1	07/18/2022	2023.01	07/18/2022 08:25:40 AM Eastern Daylight Time	08/02/2022 09:37:40 PM Eastern Daylight Time	08/05/2022 12:14:57 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	2	2023	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	10	1			2		1	07/18/2022	2023.01	07/18/2022 08:25:28 AM Eastern Daylight Time	08/02/2022 09:38:52 PM Eastern Daylight Time	08/05/2022 12:15:35 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	4	2023	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	10	1			2		1	07/18/2022	2023.01	07/18/2022 08:25:16 AM Eastern Daylight Time	08/02/2022 09:40:13 PM Eastern Daylight Time	08/05/2022 12:16:14 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	5	2023	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	8	1			2	0	0	07/18/2022	2023.01	07/18/2022 08:25:03 AM Eastern Daylight Time	07/21/2022 04:43:40 PM Eastern Daylight Time				07/26/2022 01:26:18 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Basic (HMO-POS)	01	02		1			H3957	043	1	2023	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	8	1			2	0	0	07/18/2022	2023.01	07/18/2022 08:24:52 AM Eastern Daylight Time	07/21/2022 04:26:35 PM Eastern Daylight Time				07/26/2022 01:26:18 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	2023	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	10	1			2		0	07/18/2022	2023.01	07/18/2022 08:24:25 AM Eastern Daylight Time	08/02/2022 09:41:27 PM Eastern Daylight Time	08/05/2022 12:16:52 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS ValueRx (HMO-POS)	01	02		1			H3957	044	1	2023	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	10	1			2		0	07/18/2022	2023.01	07/18/2022 08:24:13 AM Eastern Daylight Time	08/02/2022 09:42:40 PM Eastern Daylight Time	08/05/2022 12:17:31 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS ValueRx (HMO-POS)	01	02		1			H3957	044	4	2023	Western PA	North West 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	1	1	02	01	H3957_045_1	10	1			2		0	07/18/2022	2023.01	07/18/2022 08:24:01 AM Eastern Daylight Time	08/02/2022 09:43:54 PM Eastern Daylight Time	08/05/2022 12:18:10 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Standard (HMO-POS)	01	02		1			H3957	045	1	2023	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	10	1			2		0	07/18/2022	2023.01	07/18/2022 08:23:46 AM Eastern Daylight Time	08/02/2022 09:44:58 PM Eastern Daylight Time	08/05/2022 12:18:49 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Standard (HMO-POS)	01	02		1			H3957	045	2	2023	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	10	1			2		0	07/18/2022	2023.01	07/18/2022 08:23:33 AM Eastern Daylight Time	08/02/2022 09:46:09 PM Eastern Daylight Time	08/05/2022 12:19:28 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Deluxe (HMO-POS)	01	02		1			H3957	046	1	2023	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	10	1			2		0	07/18/2022	2023.01	07/18/2022 08:23:21 AM Eastern Daylight Time	08/02/2022 09:47:16 PM Eastern Daylight Time	08/05/2022 12:20:05 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Deluxe (HMO-POS)	01	02		1			H3957	046	2	2023	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	10	1			2		0	07/18/2022	2023.01	07/18/2022 08:23:09 AM Eastern Daylight Time	08/02/2022 09:48:29 PM Eastern Daylight Time	08/05/2022 12:20:53 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	047	1	2023	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	10	1			2		0	07/18/2022	2023.01	07/18/2022 08:22:57 AM Eastern Daylight Time	08/02/2022 09:49:21 PM Eastern Daylight Time	08/05/2022 12:21:33 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	047	2	2023	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	047	3	1	01	01	H3957_047_3	10	1			2		0	07/18/2022	2023.01	07/18/2022 08:22:45 AM Eastern Daylight Time	08/02/2022 09:50:32 PM Eastern Daylight Time	08/05/2022 12:22:11 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	047	3	2023	Western PA	5 County 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	048	0	1	01	01	H3957_048_0	9	1			2		0	07/18/2022	2023.01	07/18/2022 08:22:33 AM Eastern Daylight Time	08/02/2022 09:51:39 PM Eastern Daylight Time	08/05/2022 12:22:49 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Together Blue Medicare HMO Signature (HMO)	01	01		1			H3957	048	0	2023	5 County Western PA		2		2			2									medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)328-5704		(888)328-5704		(866)423-1526		(866)423-1526		(888)328-5704		(888)328-5704		(866)423-1526		(866)423-1526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	805	0	1	01	01	H3957_805_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 02:18:56 PM Eastern Daylight Time					06/03/2022 06:57:37 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO MA Calendar (HMO)	01	01		1			H3957	805	0	2023	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;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	3	1						06/02/2022	2023.01	06/02/2022 02:18:44 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	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;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	3	1						06/02/2022	2023.01	06/02/2022 02:23:14 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	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;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	3	1				0	0	06/02/2022	2023.01	06/02/2022 02:18:20 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	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;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b;11c;15;16b;	2		1					1				
H3957	811	0	1	01	01	H3957_811_0	3	1						06/02/2022	2023.01	06/02/2022 02:18:09 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	Pennsylvania (Western and North Central)		1	8526	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;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	3	1						06/02/2022	2023.01	06/02/2022 02:17:57 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	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;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	3	1				0	0	06/02/2022	2023.01	06/02/2022 04:22:15 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	Western PA		1	9684	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;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;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	3	1						06/02/2022	2023.01	06/02/2022 04:22:40 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	Western PA		1	70768	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;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;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	3	1						06/02/2022	2023.01	06/02/2022 04:23:39 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	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;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;5;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;15;	2		1				
H3957	816	0	1	01	01	H3957_816_0	3	1						06/02/2022	2023.01	06/02/2022 04:23:50 PM Eastern Daylight Time					06/03/2022 06:57:37 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO MAPD ASO CALENDAR (HMO)	01	01		1			H3957	816	0	2023	PA (South and 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;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	817	0	1	02	01	H3957_817_0	3	1						06/02/2022	2023.01	06/02/2022 04:24:20 PM Eastern Daylight Time					06/03/2022 06:57:37 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS MAPD ASO CALENDAR (HMO-POS)	01	02		1			H3957	817	0	2023	PA (South and 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;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;5;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;15;	2		1				
H3957	818	0	1	01	01	H3957_818_0	3	1						06/02/2022	2023.01	06/02/2022 02:29:11 PM Eastern Daylight Time					06/03/2022 06:57:37 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO MAPD ASO CALENDAR (HMO)	01	01		1			H3957	818	0	2023	PA (South and Western PA)		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;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				
H3959	001	0	1	01	01	H3959_001_0	2	1			1		1	05/31/2022	2023.01	05/31/2022 12:19:28 PM Eastern Daylight Time	08/03/2022 12:41:14 PM Eastern Daylight Time	07/31/2022 10:48:18 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (HMO)	01	01		1			H3959	001	0	2023	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	2	1			1		1	05/31/2022	2023.01	05/31/2022 12:20:43 PM Eastern Daylight Time	08/03/2022 12:42:29 PM Eastern Daylight Time	07/31/2022 10:48:46 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (HMO)	01	01		1			H3959	002	0	2023	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	02	01	H3959_010_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:41:26 PM Eastern Daylight Time	08/03/2022 12:44:00 PM Eastern Daylight Time	07/31/2022 10:49:14 PM Eastern Daylight Time			08/10/2022 03:19:02 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (HMO-POS)	01	02		1			H3959	010	0	2023	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	02	01	H3959_011_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:42:10 PM Eastern Daylight Time	08/03/2022 12:45:10 PM Eastern Daylight Time	07/31/2022 10:49:40 PM Eastern Daylight Time			08/10/2022 03:19:02 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (HMO-POS)	01	02		1			H3959	011	0	2023	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	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:42:54 PM Eastern Daylight Time	08/03/2022 12:46:18 PM Eastern Daylight Time	07/31/2022 10:50:08 PM Eastern Daylight Time			08/10/2022 03:19:02 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	2023	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	05/31/2022	2023.01	05/31/2022 12:27:37 PM Eastern Daylight Time	08/03/2022 12:47:25 PM Eastern Daylight Time	07/31/2022 10:50:36 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier (HMO)	01	01		1			H3959	033	0	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 07:28:35 PM Eastern Daylight Time	08/03/2022 12:48:36 PM Eastern Daylight Time	07/31/2022 10:51:06 PM Eastern Daylight Time			08/04/2022 04:51:09 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	2023	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	2	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 01:47:33 PM Eastern Daylight Time	08/03/2022 12:50:22 PM Eastern Daylight Time	07/31/2022 10:51:34 PM Eastern Daylight Time			08/04/2022 04:51:09 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	2023	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	2	1			2		0	08/02/2022	2023.01	08/02/2022 04:17:33 PM Eastern Daylight Time	08/03/2022 12:51:30 PM Eastern Daylight Time	07/31/2022 10:52:00 PM Eastern Daylight Time			08/04/2022 04:51:09 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	2023	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	05/31/2022	2023.01	05/31/2022 12:30:35 PM Eastern Daylight Time	08/03/2022 12:52:40 PM Eastern Daylight Time	07/31/2022 10:52:28 PM Eastern Daylight Time			08/04/2022 04:51:09 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	2023	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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 12:32:35 PM Eastern Daylight Time	06/01/2022 02:47:29 PM Eastern Daylight Time				06/02/2022 12:35:46 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Eagle (HMO)	01	01		1			H3959	041	0	2023	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	08/02/2022	2023.01	08/02/2022 12:53:15 PM Eastern Daylight Time	08/03/2022 12:55:03 PM Eastern Daylight Time	07/31/2022 10:52:56 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PennHighlands Prime (HMO)	01	01		1			H3959	045	0	2023	Select counties in 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	046	0	1	01	01	H3959_046_0	2	1			1		0	08/02/2022	2023.01	08/02/2022 12:57:54 PM Eastern Daylight Time	08/03/2022 12:57:02 PM Eastern Daylight Time	07/31/2022 10:53:24 PM Eastern Daylight Time			08/04/2022 04:51:09 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	2023	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	2	1			1		1	08/02/2022	2023.01	08/02/2022 01:35:36 PM Eastern Daylight Time	08/03/2022 12:58:14 PM Eastern Daylight Time	07/31/2022 10:53:52 PM Eastern Daylight Time			08/04/2022 04:51:09 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	2023	Butler and Clarion 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	049	0	1	02	01	H3959_049_0	2	1			1		0	08/02/2022	2023.01	08/02/2022 01:40:03 PM Eastern Daylight Time	08/03/2022 12:59:22 PM Eastern Daylight Time	07/31/2022 10:54:20 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Excela Prime (HMO-POS)	01	02		1			H3959	049	0	2023	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	2	1			1		1	08/02/2022	2023.01	08/02/2022 01:46:54 PM Eastern Daylight Time	08/03/2022 01:00:42 PM Eastern Daylight Time	07/31/2022 10:54:48 PM Eastern Daylight Time			08/04/2022 04:51:09 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	2023	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	08/02/2022	2023.01	08/02/2022 04:44:01 PM Eastern Daylight Time	08/03/2022 01:01:59 PM Eastern Daylight Time	07/31/2022 10:55:16 PM Eastern Daylight Time			08/04/2022 04:51:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Value (HMO)	01	01		1			H3959	052	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 04:45:18 PM Eastern Daylight Time	08/03/2022 01:04:31 PM Eastern Daylight Time	07/31/2022 10:55:44 PM Eastern Daylight Time			08/04/2022 04:51:09 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	2023	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	08/10/2022	2023.01	08/10/2022 02:43:46 PM Eastern Daylight Time	08/03/2022 01:05:40 PM Eastern Daylight Time	07/31/2022 10:56:12 PM Eastern Daylight Time			08/10/2022 03:19:02 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	2023	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	05/31/2022	2023.01	05/31/2022 12:45:26 PM Eastern Daylight Time	06/01/2022 02:41:38 PM Eastern Daylight Time				06/02/2022 12:35:46 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Eagle (HMO-POS)	01	02		1			H3959	056	0	2023	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	05/31/2022	2023.01	05/31/2022 12:47:13 PM Eastern Daylight Time	06/01/2022 02:43:03 PM Eastern Daylight Time				06/02/2022 12:35:46 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Eagle (HMO)	01	01		1			H3959	057	0	2023	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	063	0	1	01	01	H3959_063_0	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 07:29:02 PM Eastern Daylight Time	08/03/2022 01:09:03 PM Eastern Daylight Time	07/31/2022 10:56:40 PM Eastern Daylight Time			08/04/2022 04:51:09 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	2023	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	066	0	1	01	01	H3959_066_0	4	1		1	2		0	08/09/2022	2023.01	08/09/2022 03:19:36 PM Central Daylight Time	08/03/2022 01:27:00 PM Central Daylight Time	07/31/2022 09:57:08 PM Central Daylight Time			08/09/2022 03:21:44 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Longevity Plan (HMO I-SNP)	01	01		1			H3959	066	0	2023	Pennsylvania		2		2			1	1	1							www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(844)826-5291		(844)826-5291		(855)593-1245		(855)593-1245		(844)826-5291		(844)826-5291		(855)593-1245		(855)593-1245		(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	05/27/2022	2023.01	05/27/2022 09:32:14 AM Eastern Daylight Time					06/02/2022 03:20:11 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3959	803	0	2023	Pennsylvania		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3959	804	0	1	01	01	H3959_804_0	1	1						05/27/2022	2023.01	05/27/2022 09:26:31 AM Eastern Daylight Time					06/02/2022 03:20:11 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	2023	Pennsylvania		1	114780	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H3962	001	0	1	01	01	H3962_001_0	3	1					1	07/13/2022	2023.01	07/13/2022 05:39:42 PM Eastern Daylight Time	08/02/2022 02:45:48 PM Eastern Daylight Time	08/04/2022 12:00:36 PM Eastern Daylight Time			08/04/2022 05:29:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Capital Blue Cross	www.capitalbluemedicare.com	BlueJourney Premier (HMO)	01	01		1			H3962	001	0	2023	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	3	1					1	07/14/2022	2023.01	07/14/2022 08:33:16 AM Eastern Daylight Time	08/02/2022 02:46:26 PM Eastern Daylight Time	08/04/2022 12:01:40 PM Eastern Daylight Time			08/04/2022 05:29:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Capital Blue Cross	www.capitalbluemedicare.com	BlueJourney Value (HMO)	01	01		1			H3962	004	0	2023	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	3	1					1	08/02/2022	2023.01	08/02/2022 08:19:06 PM Eastern Daylight Time	08/02/2022 02:47:08 PM Eastern Daylight Time	08/04/2022 12:02:44 PM Eastern Daylight Time			08/04/2022 05:29:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Capital Blue Cross	www.capitalbluemedicare.com	BlueJourney Essential (HMO)	01	01		1			H3962	007	0	2023	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	3	1					1	08/02/2022	2023.01	08/02/2022 08:20:40 PM Eastern Daylight Time	08/02/2022 02:47:40 PM Eastern Daylight Time	08/04/2022 12:03:46 PM Eastern Daylight Time			08/04/2022 05:29:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Inspire (HMO)	01	01		1			H3962	021	0	2023	7 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						06/01/2022	2023.01	06/01/2022 04:43:28 PM Eastern Daylight Time					06/04/2022 04:39:23 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group Rx (CY) (HMO)	01	01		1			H3962	801	0	2023	National		1	10248	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	06/01/2022	2023.01	06/01/2022 04:51:56 PM Eastern Daylight Time					06/04/2022 04:39:23 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group No Rx (CY) (HMO)	01	01		1			H3962	802	0	2023	National		1	10248	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	813	0	1	01	01	H3962_813_0	1	1						06/01/2022	2023.01	06/01/2022 05:02:28 PM Eastern Daylight Time					06/04/2022 04:39:23 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group Custom Rx (CY) (HMO)	01	01		1			H3962	813	0	2023	National		1	10248	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						06/01/2022	2023.01	06/01/2022 05:10:35 PM Eastern Daylight Time					06/04/2022 04:39:23 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group Rx (FY) (HMO)	01	01		1			H3962	817	0	2023	National		1	10248	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	828	0	1	01	01	H3962_828_0	1	1				0	0	06/01/2022	2023.01	06/01/2022 05:23:07 PM Eastern Daylight Time					06/04/2022 04:39:23 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Capital Blue Cross	www.capitalbluemedicare.com	Capital Blue Cross Group No Rx (FY) (HMO)	01	01		1			H3962	828	0	2023	National		1	10248	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				
H3975	001	0	1	04	01	H3975_001_0	5	1						08/03/2022	2023.01	08/03/2022 04:02:42 PM Eastern Daylight Time	08/03/2022 08:07:46 PM Eastern Daylight Time	07/30/2022 09:09:05 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	All counties in KY		2		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	05/29/2022	2023.01	05/29/2022 11:44:37 AM Eastern Daylight Time	06/03/2022 07:19:26 PM Eastern Daylight Time				07/15/2022 04:25:45 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	2023	All counties in KY		2		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			
H3975	004	0	1	04	01	H3975_004_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 02:06:36 PM Eastern Daylight Time	08/03/2022 08:08:58 PM Eastern Daylight Time	07/30/2022 09:09:43 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H3975	004	0	2023	All counties in KY		2		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			
H3979	001	0	1	01	01	H3979_001_0	6	1						08/03/2022	2023.01	08/03/2022 05:08:59 PM Central Daylight Time	08/05/2022 02:58:04 PM Central Daylight Time	08/03/2022 06:06:13 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross and Blue Shield of Oklahoma	getblueok.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3979	001	0	2023	Oklahoma		2		2			2									getblueok.com/mapd/pharmacies	getblueok.com/mapd/druglist	getblueok.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3979	005	0	1	01	01	H3979_005_0	6	1						08/03/2022	2023.01	08/03/2022 05:09:13 PM Central Daylight Time	08/05/2022 02:59:37 PM Central Daylight Time	08/03/2022 06:07:32 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross and Blue Shield of Oklahoma	getblueok.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3979	005	0	2023	Tulsa and Surrounding Counties		2		2			2									getblueok.com/mapd/pharmacies	getblueok.com/mapd/druglist	getblueok.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3979	801	0	1	01	01	H3979_801_0	3	1						06/02/2022	2023.01	06/02/2022 12:09:54 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross and Blue Shield of Oklahoma	getblueok.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3979	801	0	2023	State of Oklahoma		1	1	2			2									www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	getblueok.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3979	803	0	1	01	01	H3979_803_0	3	1						06/02/2022	2023.01	06/02/2022 12:10:21 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross and Blue Shield of Oklahoma	getblueok.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3979	803	0	2023	State of Oklahoma		1	1	2			2									www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	getblueok.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3979	805	0	1	01	01	H3979_805_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 12:11:05 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross and Blue Shield of Oklahoma	getblueok.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3979	805	0	2023	State of Oklahoma		1	1	2			2									www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	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						06/02/2022	2023.01	06/02/2022 06:56:29 PM Cuba Daylight Time		06/02/2022 07:16:00 PM Cuba Daylight Time			06/02/2022 07:17:27 PM 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	2023	Northern Virginia		2	1381	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						06/02/2022	2023.01	06/02/2022 06:56:44 PM Cuba Daylight Time		06/02/2022 07:16:00 PM Cuba Daylight Time			06/02/2022 07:17:27 PM 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	2023	Northern Virginia		2		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	8	1		1	1		1	07/13/2022	2023.01	07/13/2022 03:54:04 PM SA Western Standard Time	08/03/2022 01:39:20 PM SA Western Standard Time	08/03/2022 12:11:20 PM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Supremo (HMO C-SNP)	01	01		1			H4003	009	0	2023	Puerto Rico		2		2			1	4			00000000000000000010000					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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7e1;7e2;7g;7h1;7h2;8a2;8b1;9a2;	
H4003	017	0	1	01	01	H4003_017_0	8	1	1	1	1		0	06/01/2022	2023.01	06/01/2022 10:16:47 AM SA Western Standard Time	08/03/2022 01:40:34 PM SA Western Standard Time	08/03/2022 12:23:20 PM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Diamante Platino (HMO D-SNP)	01	01		1			H4003	017	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4003	019	0	1	02	01	H4003_019_0	9	1			1		1	07/13/2022	2023.01	07/13/2022 03:53:25 PM SA Western Standard Time	08/03/2022 01:41:42 PM SA Western Standard Time	08/03/2022 12:48:12 PM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Unico (HMO-POS)	01	02		1			H4003	019	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	8a2;8b1;9a2;	
H4003	034	0	1	02	01	H4003_034_0	8	1			1		1	07/13/2022	2023.01	07/13/2022 03:54:26 PM SA Western Standard Time	08/03/2022 01:43:02 PM SA Western Standard Time	08/03/2022 01:00:46 PM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Elite (HMO-POS)	01	02		1			H4003	034	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7g;8a2;8b1;9a2;	
H4003	047	0	1	01	01	H4003_047_0	8	1	1	1	1		0	06/01/2022	2023.01	06/01/2022 10:16:23 AM SA Western Standard Time	08/03/2022 01:44:44 PM SA Western Standard Time	08/03/2022 01:16:02 PM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Valor Platino (HMO D-SNP)	01	01		1			H4003	047	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4003	049	0	1	01	01	H4003_049_0	11	1	1	1	1		0	06/01/2022	2023.01	06/01/2022 02:24:43 PM SA Western Standard Time	08/03/2022 01:46:50 PM SA Western Standard Time	08/04/2022 03:10:32 PM SA Western Standard Time			08/04/2022 03:42:54 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Grande Platino (HMO D-SNP)	01	01		1			H4003	049	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4003	051	0	1	02	01	H4003_051_0	12	1			1		1	07/13/2022	2023.01	07/13/2022 03:54:54 PM SA Western Standard Time	08/03/2022 01:48:02 PM SA Western Standard Time	08/04/2022 03:11:06 PM SA Western Standard Time			08/04/2022 03:42:54 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Dinamico (HMO-POS)	01	02		1			H4003	051	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;7e1;7e2;7g;7h1;7h2;8a2;8b1;9a2;	
H4003	052	0	1	01	01	H4003_052_0	8	1		1	1		1	07/13/2022	2023.01	07/13/2022 03:55:22 PM SA Western Standard Time	08/03/2022 01:49:28 PM SA Western Standard Time	08/02/2022 09:55:52 AM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Integral (HMO C-SNP)	01	01		1			H4003	052	0	2023	Puerto Rico		2		2			1	4			00000000000000000010000					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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;7e1;7e2;7g;7h1;7h2;8a2;8b1;9a2;	
H4003	053	0	1	01	01	H4003_053_0	10	1		1	1		1	07/13/2022	2023.01	07/13/2022 03:55:45 PM SA Western Standard Time	08/03/2022 03:03:50 PM SA Western Standard Time	08/02/2022 09:56:56 AM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Vibrante (HMO C-SNP)	01	01		1			H4003	053	0	2023	Puerto Rico Northwest		2		2			1	4			00000000000000000010000					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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;7e1;7e2;7g;7h1;7h2;8a2;8b1;9a2;	
H4003	054	0	1	02	01	H4003_054_0	10	1			1		1	07/13/2022	2023.01	07/13/2022 03:56:09 PM SA Western Standard Time	08/03/2022 02:58:08 PM SA Western Standard Time	08/02/2022 09:58:34 AM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Encanto (HMO-POS)	01	02		1			H4003	054	0	2023	Puerto Rico Northwest		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7g;8a2;8b1;9a2;	
H4003	055	0	1	02	01	H4003_055_0	9	1			1		1	07/13/2022	2023.01	07/13/2022 03:56:42 PM SA Western Standard Time	08/03/2022 03:06:08 PM SA Western Standard Time	08/02/2022 09:59:20 AM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Deluxe (HMO-POS)	01	02		1			H4003	055	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;7e1;7e2;7f;7g;7h1;7h2;8a2;8b1;9a2;	
H4003	057	0	1	02	01	H4003_057_0	9	1			1		1	07/13/2022	2023.01	07/13/2022 03:57:02 PM SA Western Standard Time	08/03/2022 03:10:14 PM SA Western Standard Time	08/02/2022 10:00:26 AM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Flexi Max (HMO-POS)	01	02		1			H4003	057	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;7e1;7e2;7f;7g;7h1;7h2;8a2;8b1;9a2;	
H4003	058	0	1	01	01	H4003_058_0	9	1	1	1	1		0	06/01/2022	2023.01	06/01/2022 10:18:26 AM SA Western Standard Time	08/03/2022 03:18:12 PM SA Western Standard Time	08/02/2022 10:02:32 AM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Dorado Platino (HMO D-SNP)	01	01		1			H4003	058	0	2023	Puerto Rico Northwest		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4003	806	0	1	02	01	H4003_806_0	3	1						05/17/2022	2023.01	05/17/2022 10:44:45 AM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group A Calendar (HMO-POS)	01	02		1			H4003	806	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:35:57 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group B Calendar (HMO-POS)	01	02		1			H4003	807	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 05:51:54 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group C Calendar (HMO-POS)	01	02		1			H4003	820	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 05:55:15 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group D Calendar (HMO-POS)	01	02		1			H4003	821	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:37:20 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group A Non-Calendar (HMO-POS)	01	02		1			H4003	822	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:37:47 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group B Non-Calendar (HMO-POS)	01	02		1			H4003	823	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 05:55:31 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group C Non-Calendar (HMO-POS)	01	02		1			H4003	824	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 05:55:49 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group D Non-Calendar (HMO-POS)	01	02		1			H4003	825	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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						05/18/2022	2023.01	05/18/2022 06:38:08 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group E Calendar (HMO-POS)	01	02		1			H4003	826	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:38:29 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group E Non-Calendar (HMO-POS)	01	02		1			H4003	827	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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	828	0	1	02	01	H4003_828_0	3	1						05/18/2022	2023.01	05/18/2022 05:56:44 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group F Calendar (HMO-POS)	01	02		1			H4003	828	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;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	829	0	1	02	01	H4003_829_0	3	1						05/18/2022	2023.01	05/18/2022 05:57:05 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Group F Non-Calendar (HMO-POS)	01	02		1			H4003	829	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;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	8	1	1	1	1		0	06/01/2022	2023.01	06/01/2022 12:33:19 PM SA Western Standard Time	08/03/2022 03:21:02 PM SA Western Standard Time	08/03/2022 01:22:46 PM SA Western Standard Time			08/03/2022 05:23:59 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	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4004	056	0	1	02	01	H4004_056_0	9	1			1		1	07/13/2022	2023.01	07/13/2022 03:57:26 PM SA Western Standard Time	08/03/2022 03:24:54 PM SA Western Standard Time	08/03/2022 01:22:20 PM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Max (HMO-POS)	01	02		1			H4004	056	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7d;7e1;7e2;7f;7g;7h1;7h2;8a2;8b1;9a2;	7f;
H4004	062	0	1	01	01	H4004_062_0	11	1	1	1	1		0	06/03/2022	2023.01	06/03/2022 11:42:19 AM SA Western Standard Time	08/03/2022 03:26:58 PM SA Western Standard Time	08/04/2022 03:11:26 PM SA Western Standard Time			08/04/2022 03:42:54 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	MMM Relax Platino (HMO D-SNP)	01	01		1			H4004	062	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4004	063	0	1	02	01	H4004_063_0	9	1			1		1	07/13/2022	2023.01	07/13/2022 03:57:44 PM SA Western Standard Time	08/03/2022 03:29:24 PM SA Western Standard Time	08/02/2022 10:08:24 AM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	MMM Balance (HMO-POS)	01	02		1			H4004	063	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;7e1;7e2;7g;7h1;7h2;8a2;8b1;9a2;	
H4004	065	0	1	02	01	H4004_065_0	8	1			1		1	07/13/2022	2023.01	07/13/2022 03:58:05 PM SA Western Standard Time	08/03/2022 03:33:46 PM SA Western Standard Time	08/02/2022 10:09:18 AM SA Western Standard Time			08/03/2022 05:23:59 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	MMM Plenitud (HMO-POS)	01	02		1			H4004	065	0	2023	Puerto Rico		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7g;8a2;8b1;9a2;	
H4004	817	0	1	02	01	H4004_817_0	3	1						05/18/2022	2023.01	05/18/2022 06:47:54 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:52:29 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:56:35 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:14:51 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:18:01 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:17:48 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:17:33 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:17:13 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:55:51 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:16:42 PM SA Western Standard Time					06/03/2022 08:24:07 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;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	828	0	1	02	01	H4004_828_0	3	1						05/18/2022	2023.01	05/18/2022 06:55:44 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group F Calendar (HMO-POS)	01	02		1			H4004	828	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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	829	0	1	02	01	H4004_829_0	3	1						05/18/2022	2023.01	05/18/2022 06:15:41 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group F Non-Calendar (HMO-POS)	01	02		1			H4004	829	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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				0	0	07/06/2022	2023.01	07/06/2022 10:14:32 AM SA Western Standard Time	06/06/2022 09:12:04 PM SA Western Standard Time				07/06/2022 03:31:52 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	01	04		1			H4005	001	0	2023	Puerto Rico		2		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;7j;8a1;8a2;8b1;8b2;8b3;	7f;
H4005	004	0	1	04	01	H4005_004_0	7	1					0	08/03/2022	2023.01	08/03/2022 04:19:33 PM SA Western Standard Time	08/03/2022 04:31:28 PM SA Western Standard Time	07/31/2022 12:43:22 PM SA Western Standard Time			08/05/2022 01:53:02 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo Plus (PPO)	01	04		1			H4005	004	0	2023	Puerto Rico		2		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;7g;7j;8b1;8b2;8b3;	7f;
H4005	007	0	1	04	01	H4005_007_0	7	1					0	08/03/2022	2023.01	08/03/2022 04:20:27 PM SA Western Standard Time	08/03/2022 04:31:52 PM SA Western Standard Time	07/31/2022 12:43:42 PM SA Western Standard Time			08/05/2022 01:53:02 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	Optimo Xtra (PPO)	01	04		1			H4005	007	0	2023	Puerto Rico		2		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;7g;7j;8b1;8b2;8b3;	7f;
H4005	801	0	1	04	01	H4005_801_0	6	1				0	0	05/23/2022	2023.01	05/23/2022 08:44:08 AM SA Western Standard Time					06/06/2022 09:52:37 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	01	04		1			H4005	801	0	2023	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;10a;11a;11b;15;16b;	2		1									
H4005	802	0	1	04	01	H4005_802_0	7	1						06/17/2022	2023.01	06/17/2022 04:46:13 PM SA Western Standard Time					06/17/2022 04:48:33 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	2023	Puerto Rico		1	21240	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		2									
H4005	804	0	1	04	01	H4005_804_0	7	1						06/17/2022	2023.01	06/17/2022 04:46:30 PM SA Western Standard Time					06/17/2022 04:48:33 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	2023	Puerto Rico		1	1068	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	6	1						05/23/2022	2023.01	05/23/2022 11:54:22 AM SA Western Standard Time					06/06/2022 09:52:37 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	2023	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									
H4005	808	0	1	04	01	H4005_808_0	7	1						06/17/2022	2023.01	06/17/2022 04:46:50 PM SA Western Standard Time					06/17/2022 04:48:33 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	2023	Puerto Rico		1	16920	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;10a;11a;11b;15;16b;	2		1									
H4007	012	0	1	01	01	H4007_012_0	6	1			1		1	08/03/2022	2023.01	08/03/2022 02:40:03 PM Eastern Daylight Time	08/03/2022 03:41:45 PM Eastern Daylight Time	08/02/2022 09:58:24 AM Eastern Daylight Time			08/04/2022 02:11:25 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	2023	Puerto Rico Island Wide		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1	1	1	1		0	08/03/2022	2023.01	08/03/2022 02:41:09 PM Eastern Daylight Time	08/03/2022 03:40:45 PM Eastern Daylight Time	07/30/2022 06:35:44 AM Eastern Daylight Time			08/04/2022 02:02:59 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	2023	Puerto Rico Island Wide		2		2		1	1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1	1	1	1		0	08/03/2022	2023.01	08/03/2022 03:07:50 PM Eastern Daylight Time	08/03/2022 03:41:16 PM Eastern Daylight Time	07/30/2022 06:36:08 AM Eastern Daylight Time			08/04/2022 02:11:25 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	2023	Puerto Rico Island Wide		2		2		1	1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	5	1	1	1	1		0	08/01/2022	2023.01	08/01/2022 02:35:55 PM Eastern Daylight Time	08/03/2022 03:42:17 PM Eastern Daylight Time	07/30/2022 06:36:34 AM Eastern Daylight Time			08/04/2022 02:11:25 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	2023	Puerto Rico Island Wide		2		2		1	1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4007	020	0	1	01	01	H4007_020_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 12:20:27 PM Eastern Daylight Time	08/03/2022 03:42:47 PM Eastern Daylight Time	08/04/2022 08:35:59 AM Eastern Daylight Time			08/04/2022 02:02:59 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	2023	Puerto Rico Island Wide		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	5	1			1		1	08/03/2022	2023.01	08/03/2022 03:09:21 PM Eastern Daylight Time	08/03/2022 03:43:18 PM Eastern Daylight Time	07/30/2022 06:37:24 AM Eastern Daylight Time			08/04/2022 02:02:59 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	2023	Puerto Rico Island Wide		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	08/01/2022	2023.01	08/01/2022 02:37:35 PM Eastern Daylight Time	08/03/2022 03:43:48 PM Eastern Daylight Time	07/30/2022 06:37:48 AM Eastern Daylight Time			08/04/2022 02:02:59 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	2023	Puerto Rico Island Wide		2		2		1	1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	024	0	1	01	01	H4007_024_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:39:02 PM Eastern Daylight Time	08/03/2022 03:44:18 PM Eastern Daylight Time	07/30/2022 06:38:14 AM Eastern Daylight Time			08/04/2022 02:02:59 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4007-024 (HMO)	01	01		1			H4007	024	0	2023	Puerto Rico Island Wide		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	025	0	1	01	01	H4007_025_0	4	1			2		1	08/01/2022	2023.01	08/01/2022 12:37:55 PM Eastern Daylight Time	08/03/2022 03:44:48 PM Eastern Daylight Time	07/30/2022 06:38:38 AM Eastern Daylight Time			08/04/2022 02:02:59 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4007-025 (HMO)	01	01		1			H4007	025	0	2023	Puerto Rico Island Wide		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	026	0	1	01	01	H4007_026_0	4	1	1	1	1		0	08/01/2022	2023.01	08/01/2022 02:40:29 PM Eastern Daylight Time	08/03/2022 03:45:18 PM Eastern Daylight Time	07/30/2022 06:39:02 AM Eastern Daylight Time			08/04/2022 02:11:25 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-026 (HMO D-SNP)	01	01		1			H4007	026	0	2023	Puerto Rico Island Wide		2		2		1	1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	027	0	1	01	01	H4007_027_0	3	1	1	1	1		0	08/01/2022	2023.01	08/01/2022 02:41:50 PM Eastern Daylight Time	08/03/2022 03:45:49 PM Eastern Daylight Time	07/30/2022 06:39:28 AM Eastern Daylight Time			08/04/2022 02:11:25 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP)	01	01		1			H4007	027	0	2023	Puerto Rico Island Wide		2		2		1	1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1						06/02/2022	2023.01	06/02/2022 06:00:23 PM Eastern Daylight Time					06/02/2022 06:01:57 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	801	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 04:47:39 PM Eastern Daylight Time					06/02/2022 06:01:57 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	802	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	815	0	1	01	01	H4007_815_0	3	1						05/27/2022	2023.01	05/27/2022 04:51:21 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 04:55:55 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1						05/27/2022	2023.01	05/27/2022 04:59:32 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	21416	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 05:02:34 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1						05/27/2022	2023.01	05/27/2022 05:05:23 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 05:09:19 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1						05/27/2022	2023.01	05/27/2022 05:12:42 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 05:15:27 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1						05/27/2022	2023.01	05/27/2022 05:18:17 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 05:20:37 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1						05/27/2022	2023.01	05/27/2022 05:23:23 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 05:25:53 PM Eastern Daylight Time					06/02/2022 06:01:57 PM 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	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	827	0	1	01	01	H4007_827_0	3	1						06/02/2022	2023.01	06/02/2022 09:06:15 AM Eastern Daylight Time					06/02/2022 06:01:57 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	827	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	828	0	1	01	01	H4007_828_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 09:11:46 AM Eastern Daylight Time					06/02/2022 06:01:57 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	828	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	829	0	1	01	01	H4007_829_0	3	1						06/02/2022	2023.01	06/02/2022 09:15:37 AM Eastern Daylight Time					06/02/2022 06:01:57 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	829	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	830	0	1	01	01	H4007_830_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 09:19:01 AM Eastern Daylight Time					06/02/2022 06:01:57 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	830	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	831	0	1	01	01	H4007_831_0	1	1						06/03/2022	2023.01	06/03/2022 09:35:09 AM Eastern Daylight Time					06/03/2022 09:39:48 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	831	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	832	0	1	01	01	H4007_832_0	1	1				0	0	06/03/2022	2023.01	06/03/2022 09:39:13 AM Eastern Daylight Time					06/03/2022 09:39:48 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	832	0	2023	Puerto Rico - Island Wide		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	5	1					0	05/25/2022	2023.01	05/25/2022 09:46:47 AM Venezuela Standard Time	08/04/2022 06:17:41 PM Venezuela Standard Time	08/04/2022 06:31:45 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard 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	2023	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	5	1					0	05/24/2022	2023.01	05/24/2022 11:05:51 AM Eastern Daylight Time	08/04/2022 06:17:01 PM Eastern Daylight Time	08/04/2022 06:30:31 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1					1	08/01/2022	2023.01	08/01/2022 02:39:49 PM Venezuela Standard Time	08/04/2022 06:17:42 PM Venezuela Standard Time	08/04/2022 06:31:47 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard 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	2023	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	4	1				0	0	05/24/2022	2023.01	05/24/2022 11:43:21 AM Eastern Daylight Time	07/19/2022 05:09:03 PM Eastern Daylight Time				07/19/2022 07:50:24 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	2023	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	09/23/2022	2023.01	09/23/2022 03:51:20 PM Eastern Daylight Time	08/04/2022 06:17:03 PM Eastern Daylight Time	08/04/2022 06:30:34 PM Eastern Daylight Time			09/27/2022 09:10:42 AM 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	2023	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	4	1				0	0	05/25/2022	2023.01	05/25/2022 09:47:58 AM Venezuela Standard Time	07/19/2022 05:09:56 PM Venezuela Standard Time				07/19/2022 06:26:52 PM Venezuela Standard 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	2023	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	5	1					0	05/24/2022	2023.01	05/24/2022 11:07:12 AM Eastern Daylight Time	08/04/2022 06:17:04 PM Eastern Daylight Time	08/04/2022 06:30:36 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	026	0	1	04	01	H4036_026_0	5	1					1	08/01/2022	2023.01	08/01/2022 03:56:32 PM Eastern Daylight Time	08/04/2022 06:17:06 PM Eastern Daylight Time	08/04/2022 06:30:39 PM Eastern Daylight Time			08/04/2022 09:35:16 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			H4036	026	0	2023	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	4	1						06/16/2022	2023.01	06/16/2022 02:40:18 PM Pacific Daylight Time					06/17/2022 08:11:20 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	2023	National		1	1406280	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;15;16b;18a;	2		1									
H4036	802	0	1	04	01	H4036_802_0	4	1				0	0	06/16/2022	2023.01	06/16/2022 02:41:02 PM Pacific Daylight Time					06/17/2022 08:11:20 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	2023	National		1	1040338	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;15;16b;18a;	2		1									
H4036	805	0	1	04	01	H4036_805_0	2	1						05/23/2022	2023.01	05/23/2022 02:14:58 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	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;15;16b;18a;	2		1									
H4036	806	0	2	04	01	H4036_806_0	2	1						05/23/2022	2023.01	05/23/2022 02:15:05 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	National		1	1740	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;15;16b;18a;	2		1									
H4036	807	0	1	04	01	H4036_807_0	3	1				0	0	06/16/2022	2023.01	06/16/2022 02:42:46 PM Pacific Daylight Time					06/17/2022 08:11:20 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	2023	National		1	23328	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;15;16b;18a;	2		1									
H4036	809	0	2	04	01	H4036_809_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:15:23 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	National		1	3684	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;15;16b;18a;	2		1									
H4036	810	0	2	04	01	H4036_810_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:15:40 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	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;15;16b;18a;	2		1									
H4036	812	0	1	04	01	H4036_812_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:15:48 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	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;15;16b;18a;	2		1									
H4036	813	0	1	04	01	H4036_813_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:15:58 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	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;15;16b;18a;	2		1									
H4036	814	0	1	04	01	H4036_814_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:16:08 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	National		1	600	2			2									www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(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;15;16b;18a;	2		1									
H4036	815	0	1	04	01	H4036_815_0	2	1						05/23/2022	2023.01	05/23/2022 02:16:15 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	National		1	600	2			2									www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)325-1191		(833)325-1191		(833)325-1190		(833)325-1190		(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;15;16b;18a;	2		1									
H4036	816	0	1	04	01	H4036_816_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:16:24 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	National		1	600	2			2									www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)325-1191		(833)325-1191		(833)325-1190		(833)325-1190										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;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;15;16b;18a;	2		1									
H4036	817	0	2	04	01	H4036_817_0	2	1						05/23/2022	2023.01	05/23/2022 02:16:31 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	National		1	600	2			2									www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)325-1191		(833)325-1191		(833)325-1190		(833)325-1190		(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;15;16b;18a;	2		1									
H4036	818	0	2	04	01	H4036_818_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:16:50 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	National		1	600	2			2									www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)325-1191		(833)325-1191		(833)325-1190		(833)325-1190										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;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;15;16b;18a;	2		1									
H4036	819	0	1	04	01	H4036_819_0	2	1						05/23/2022	2023.01	05/23/2022 02:16:59 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	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;15;16b;18a;	2		1									
H4036	820	0	1	04	01	H4036_820_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:17:08 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	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;15;16b;18a;	2		1									
H4036	821	0	2	04	01	H4036_821_0	2	1						05/23/2022	2023.01	05/23/2022 02:17:16 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	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;15;16b;18a;	2		1									
H4036	822	0	2	04	01	H4036_822_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:17:25 PM Pacific Daylight Time					06/03/2022 10:28:43 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	2023	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;15;16b;18a;	2		1									
H4036	823	0	1	04	01	H4036_823_0	2	1						05/23/2022	2023.01	05/23/2022 02:17:45 PM Pacific Daylight Time					06/03/2022 10:28:43 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	823	0	2023	National (MA)		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;15;16b;18a;	2		1									
H4036	824	0	1	04	01	H4036_824_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:17:55 PM Pacific Daylight Time					06/03/2022 10:28:43 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	824	0	2023	National (MA)		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;15;16b;18a;	2		1									
H4036	825	0	2	04	01	H4036_825_0	2	1						05/23/2022	2023.01	05/23/2022 02:18:02 PM Pacific Daylight Time					06/03/2022 10:28:43 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	825	0	2023	National (MA)		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;15;16b;18a;	2		1									
H4036	826	0	2	04	01	H4036_826_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:18:08 PM Pacific Daylight Time					06/03/2022 10:28:43 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	826	0	2023	National (MA)		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;15;16b;18a;	2		1									
H4036	827	0	1	04	01	H4036_827_0	2	1						05/23/2022	2023.01	05/23/2022 02:18:15 PM Pacific Daylight Time					06/03/2022 10:28:43 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	827	0	2023	National (MD)		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;15;16b;18a;	2		1									
H4036	828	0	1	04	01	H4036_828_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:18:22 PM Pacific Daylight Time					06/03/2022 10:28:43 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	828	0	2023	National (MD)		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;15;16b;18a;	2		1									
H4036	829	0	2	04	01	H4036_829_0	2	1						05/23/2022	2023.01	05/23/2022 02:18:29 PM Pacific Daylight Time					06/03/2022 10:28:43 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	829	0	2023	National (MD)		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;15;16b;18a;	2		1									
H4036	830	0	2	04	01	H4036_830_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:18:36 PM Pacific Daylight Time					06/03/2022 10:28:43 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	830	0	2023	National (MD)		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;15;16b;18a;	2		1									
H4036	831	0	1	04	01	H4036_831_0	2	1						05/23/2022	2023.01	05/23/2022 02:18:43 PM Pacific Daylight Time					06/03/2022 10:28:43 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	831	0	2023	National (DC)		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;15;16b;18a;	2		1									
H4036	832	0	1	04	01	H4036_832_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:18:50 PM Pacific Daylight Time					06/03/2022 10:28:43 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	832	0	2023	National (DC)		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;15;16b;18a;	2		1									
H4036	833	0	2	04	01	H4036_833_0	2	1						05/23/2022	2023.01	05/23/2022 02:18:56 PM Pacific Daylight Time					06/03/2022 10:28:43 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	833	0	2023	National (DC)		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;15;16b;18a;	2		1									
H4036	834	0	2	04	01	H4036_834_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:19:02 PM Pacific Daylight Time					06/03/2022 10:28:43 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	834	0	2023	National (DC)		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;15;16b;18a;	2		1									
H4045	001	0	1	01	01	H4045_001_0	5	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 10:14:41 AM Pacific Daylight Time	08/03/2022 08:56:06 AM Pacific Daylight Time	08/01/2022 09:30:23 AM Pacific Daylight Time			08/04/2022 09:18:26 AM Pacific Daylight Time	SANTA CLARA COUNTY HEALTH AUTHORITY	Santa Clara Family Health Plan	www.scfhp.com	DualConnect (HMO D-SNP)	01	01		1			H4045	001	0	2023	Santa Clara County		2		2			1	3		1					1	www.scfhp.com	www.scfhp.com	www.scfhp.com	(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)-		2					2					1	2			
H4053	001	0	1	20	08	H4053_001_0	1	1						06/01/2022	2023.01	06/01/2022 01:12:26 PM Eastern Daylight Time		06/01/2022 01:06:23 PM Eastern Daylight Time			06/01/2022 01:16:16 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	2023	Anderson, Greenville and Pickens counties		2		2			2									N/A	N/A												(864)522-1950				(864)522-1950												(711)-				(711)-																
H4053	002	0	1	20	08	H4053_002_0	1	1						06/01/2022	2023.01	06/01/2022 01:12:57 PM Eastern Daylight Time		06/01/2022 01:06:08 PM Eastern Daylight Time			06/01/2022 01:16:16 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	2023	Anderson, Greenville and Pickens counties		2		2			2									N/A	N/A												(864)522-1950				(864)522-1950												(711)-				(711)-																
H4054	001	0	1	01	01	H4054_001_0	10	1		1				07/25/2022	2023.01	07/25/2022 11:53:35 AM Eastern Daylight Time	08/04/2022 09:39:25 PM Eastern Daylight Time	08/04/2022 09:39:25 PM Eastern Daylight Time			08/04/2022 09:42:14 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	2023	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	10	1		1				07/22/2022	2023.01	07/22/2022 03:57:42 PM Eastern Daylight Time	08/04/2022 09:39:25 PM Eastern Daylight Time	08/04/2022 09:39:25 PM Eastern Daylight Time			08/04/2022 09:42:14 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	2023	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	4	1						08/01/2022	2023.01	08/01/2022 01:24:27 PM Eastern Daylight Time	08/03/2022 08:18:32 PM Eastern Daylight Time	07/30/2022 09:10:16 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NC		2		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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 01:50:02 PM Eastern Daylight Time	08/03/2022 08:19:42 PM Eastern Daylight Time	07/30/2022 09:10:48 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NC		2		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						05/26/2022	2023.01	05/26/2022 09:43:59 AM Eastern Daylight Time		05/26/2022 09:25:09 AM Eastern Daylight Time			05/26/2022 09:50:30 AM 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	2023	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	2	1						05/26/2022	2023.01	05/26/2022 09:44:50 AM Eastern Daylight Time		05/26/2022 02:37:33 PM Eastern Daylight Time			05/26/2022 02:46:55 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	2023	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				08/03/2022	2023.01	08/03/2022 05:48:57 PM Central Daylight Time	08/03/2022 11:39:53 AM Central Daylight Time	08/02/2022 11:13:43 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	SIMPRA ADVANTAGE, INC.	Simpra Advantage	www.simpra.com	Simpra Advantage (PPO I-SNP)	01	04		1			H4091	001	0	2023	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	7	1	2	1			0	08/03/2022	2023.01	08/03/2022 03:07:14 PM Central Daylight Time	08/03/2022 05:06:24 PM Central Daylight Time	08/11/2022 09:28:08 AM Central Daylight Time			08/11/2022 03:11:50 PM Central Daylight Time	SIMPRA ADVANTAGE, INC.	Simpra Advantage	www.simpra.com	Simpra Advantage (PPO D-SNP)	01	04		1			H4091	002	0	2023	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	6	1		1				06/27/2022	2023.01	06/27/2022 09:46:27 AM Central Daylight Time	08/03/2022 11:41:10 AM Central Daylight Time	08/02/2022 11:16:40 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	SIMPRA ADVANTAGE, INC.	Simpra Advantage	www.simpra.com	Simpra Advantage Premier (PPO I-SNP)	01	04		1			H4091	003	0	2023	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	12	1		1			0	08/04/2022	2023.01	08/04/2022 05:43:54 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time			08/04/2022 09:42:14 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	2023	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	10	1		1			0	08/04/2022	2023.01	08/04/2022 05:44:11 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time			08/04/2022 09:42:14 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:10:17 AM Central Daylight Time	08/03/2022 11:34:45 AM Central Daylight Time	07/31/2022 02:30:07 AM Central Daylight Time			08/04/2022 03:17:57 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)	01	02		1			H4094	001	0	2023	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						06/02/2022	2023.01	06/02/2022 04:01:24 PM Eastern Daylight Time		05/28/2022 11:10:43 AM Eastern Daylight Time			06/02/2022 04:04:40 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	2023	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						06/02/2022	2023.01	06/02/2022 04:02:23 PM Eastern Daylight Time		05/28/2022 11:12:47 AM Eastern Daylight Time			06/02/2022 04:04:40 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	2023	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						05/27/2022	2023.01	05/27/2022 10:43:49 AM Eastern Daylight Time		05/24/2022 11:56:01 PM Eastern Daylight Time			05/27/2022 11:01:40 AM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.huronvalleypace.org	Huron Valley PACE - Dual Eligible (PACE)	08	20		1			H4118	001	0	2023	Wash Co, Parts of Mon, Oak, Wayne & Livingston Co		2		2			2									http://www.hometownpharmacy.com/	http://huronvalleypace.org/										(855)483-7223		(734)572-5777		(855)483-7223		(734)572-5777										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777																
H4118	002	0	1	20	08	H4118_002_0	1	1						05/27/2022	2023.01	05/27/2022 10:44:00 AM Eastern Daylight Time		05/24/2022 11:53:48 PM Eastern Daylight Time			05/27/2022 11:01:40 AM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.huronvalleypace.org	Huron Valley PACE - Medicare Only (PACE)	08	20		1			H4118	002	0	2023	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	5	1			2		1	08/03/2022	2023.01	08/03/2022 04:45:34 PM Central Daylight Time	08/04/2022 09:07:07 AM Central Daylight Time	08/04/2022 10:05:35 AM Central Daylight Time			08/05/2022 10:17:49 AM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrMax (HMO-POS)	01	02		1			H4140	001	0	2023	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	5	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 04:45:24 PM Central Daylight Time	08/04/2022 09:07:51 AM Central Daylight Time	08/04/2022 10:06:07 AM Central Daylight Time			08/05/2022 10:17:49 AM 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	2023	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	5	1		1	2		1	08/03/2022	2023.01	08/03/2022 04:48:29 PM Central Daylight Time	08/04/2022 09:08:34 AM Central Daylight Time	08/04/2022 10:06:39 AM Central Daylight Time			08/05/2022 10:17:49 AM 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	2023	Miami-Dade County		2		2			1	4			00000000000000000100000					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	5	1			2		0	08/03/2022	2023.01	08/03/2022 04:48:51 PM Central Daylight Time	08/04/2022 09:09:16 AM Central Daylight Time	08/04/2022 10:07:12 AM Central Daylight Time			08/05/2022 10:17:49 AM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrValue (HMO-POS)	01	02		1			H4140	005	0	2023	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	5	1			2		1	08/03/2022	2023.01	08/03/2022 04:49:05 PM Central Daylight Time	08/04/2022 09:09:59 AM Central Daylight Time	08/04/2022 10:07:46 AM Central Daylight Time			08/05/2022 10:17:49 AM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrMax-B (HMO-POS)	01	02		1			H4140	009	0	2023	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	5	1	2	1	2		0	06/03/2022	2023.01	06/03/2022 07:45:44 PM Central Daylight Time	08/04/2022 09:10:43 AM Central Daylight Time	08/04/2022 10:08:20 AM Central Daylight Time			08/05/2022 10:17:49 AM 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	2023	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	5	1			2		0	08/03/2022	2023.01	08/03/2022 04:49:29 PM Central Daylight Time	08/04/2022 09:11:26 AM Central Daylight Time	08/04/2022 10:08:54 AM Central Daylight Time			08/05/2022 10:17:49 AM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrValue-B (HMO-POS)	01	02		1			H4140	011	0	2023	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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 02:49:16 PM Eastern Daylight Time	08/03/2022 05:28:29 PM Eastern Daylight Time	07/30/2022 06:39:54 AM Eastern Daylight Time			08/04/2022 03:56:59 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	2023	Greater Georgia Area		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 02:54:24 PM Eastern Daylight Time	08/03/2022 05:25:25 PM Eastern Daylight Time	07/30/2022 06:40:18 AM Eastern Daylight Time			08/04/2022 03:56:59 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	2023	Atlanta Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 02:53:25 PM Eastern Daylight Time	08/03/2022 05:28:02 PM Eastern Daylight Time	08/02/2022 10:07:04 AM Eastern Daylight Time			08/04/2022 03:56:59 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	2023	Select counties in Georgia	Select counties in Georgia	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 02:53:14 PM Eastern Daylight Time	08/03/2022 05:32:51 PM Eastern Daylight Time	08/02/2022 10:07:52 AM Eastern Daylight Time			08/04/2022 03:56:59 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	2023	Select counties in Georgia	Select counties in Georgia	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	021	0	1	01	01	H4141_021_0	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:30:43 PM Eastern Daylight Time	08/03/2022 05:46:11 PM Eastern Daylight Time	07/30/2022 06:41:06 AM Eastern Daylight Time			08/04/2022 03:29:34 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4141-021 (HMO D-SNP)	01	01		1			H4141	021	0	2023	Select counties in Georgia		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/27/2022	2023.01	05/27/2022 05:42:22 PM Eastern Daylight Time					05/27/2022 05:49:41 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4141	801	0	2023	Select counties in Georgia		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 05:44:09 PM Eastern Daylight Time					05/27/2022 05:49:41 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4141	802	0	2023	Select counties in Georgia		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/27/2022	2023.01	05/27/2022 05:46:58 PM Eastern Daylight Time					05/27/2022 05:49:41 PM 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	2023	Select counties in Georgia		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 05:49:14 PM Eastern Daylight Time					05/27/2022 05:49:41 PM 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	2023	Select counties in Georgia		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						06/01/2022	2023.01	06/01/2022 01:29:59 PM Central Daylight Time		05/27/2022 02:17:25 PM Central Daylight Time			06/01/2022 01:33:16 PM 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	2023	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						06/01/2022	2023.01	06/01/2022 01:30:43 PM Central Daylight Time		05/27/2022 02:17:25 PM Central Daylight Time			06/01/2022 01:33:16 PM 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	2023	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	9	1				0	0	07/15/2022	2023.01	07/15/2022 10:58:52 AM Eastern Daylight Time	07/19/2022 03:37:34 PM Eastern Daylight Time				07/19/2022 03:59:23 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Core (HMO)	01	01		1			H4152	004	0	2023	State of Rhode Island		2		2			2									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	1	01	7a;	
H4152	005	0	1	01	01	H4152_005_0	10	1			2		1	07/15/2022	2023.01	07/15/2022 10:51:11 AM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time			08/04/2022 02:38:52 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	2023	State of Rhode Island		2		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	11	1			2		1	07/15/2022	2023.01	07/15/2022 10:51:42 AM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time			08/04/2022 02:38:52 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	2023	State of Rhode Island		2		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	11	1			2		1	07/15/2022	2023.01	07/15/2022 10:52:16 AM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time			08/04/2022 02:38:52 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	2023	State of Rhode Island		2		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	018	0	1	02	01	H4152_018_0	10	1			2		1	07/15/2022	2023.01	07/15/2022 10:59:09 AM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time			08/04/2022 02:38:52 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	2023	State of Rhode Island		2		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	10	1			1		1	08/04/2022	2023.01	08/04/2022 02:35:06 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time			08/04/2022 02:38:52 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	2023	State of Rhode Island		2		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	10	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 02:35:33 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time	08/04/2022 02:28:43 PM Eastern Daylight Time			08/04/2022 02:38:52 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	2023	State of Rhode Island		2		2			1	3		1					2	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(800)267-0439		(401)277-2958		(855)430-9293		(401)459-5477		(800)267-0439		(401)277-2958		(855)430-9293		(401)459-5477		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4152	815	0	1	02	01	H4152_815_0	5	1						06/03/2022	2023.01	06/03/2022 12:02:45 PM Eastern Daylight Time					06/06/2022 08:44:22 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	2023	RI, Bristol Cty MA, Partial New London Cty CT		1	30128	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	5	1						06/03/2022	2023.01	06/03/2022 11:45:22 AM Eastern Daylight Time					06/06/2022 08:44:22 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	2023	RI, Bristol Cty MA, Partial New London Cty CT		1	5425	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			
H4161	001	0	1	01	01	H4161_001_0	7	1	2	1	1		0	07/20/2022	2023.01	07/20/2022 03:03:10 PM Eastern Daylight Time	08/04/2022 06:15:23 PM Eastern Daylight Time	08/04/2022 06:27:23 PM Eastern Daylight Time			08/04/2022 07:52:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Anthem Blue Cross Partnership Plan	https://shop.anthem.com/medicare	Anthem MediBlue Full Dual Advantage (HMO D-SNP)	01	01		1			H4161	001	0	2023	Los Angeles and Santa Clara Counties		2		2			1	3		1					1	https://www.shop.anthem.com/medicare	https://www.shop.anthem.com/medicare	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			
H4161	002	0	1	01	01	H4161_002_0	7	1			2		1	08/01/2022	2023.01	08/01/2022 12:53:15 PM Pacific Daylight Time	08/04/2022 03:16:19 PM Pacific Daylight Time	08/04/2022 03:29:10 PM Pacific Daylight Time			08/04/2022 07:03:00 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Anthem Blue Cross Partnership Plan	https://shop.anthem.com/medicare	Anthem MediBlue Prime (HMO)	01	01		1			H4161	002	0	2023	Riverside and San Bernardino Counties		2		2			2									https://www.shop.anthem.com/medicare	https://www.shop.anthem.com/medicare	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			
H4161	003	0	1	01	01	H4161_003_0	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:54:24 PM Pacific Daylight Time	08/04/2022 03:16:20 PM Pacific Daylight Time	08/04/2022 03:29:13 PM Pacific Daylight Time			08/04/2022 07:03:00 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Anthem Blue Cross Partnership Plan	https://shop.anthem.com/medicare	Anthem MediBlue Prime (HMO)	01	01		1			H4161	003	0	2023	San Diego County		2		2			2									https://www.shop.anthem.com/medicare	https://www.shop.anthem.com/medicare	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			
H4161	004	0	1	01	01	H4161_004_0	5	1			2		0	05/18/2022	2023.01	05/18/2022 04:50:22 PM Pacific Daylight Time	08/04/2022 03:16:21 PM Pacific Daylight Time	08/04/2022 03:29:16 PM Pacific Daylight Time			08/04/2022 07:03:00 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Anthem Blue Cross Partnership Plan	https://shop.anthem.com/medicare	Anthem MediBlue Prime (HMO)	01	01		1			H4161	004	0	2023	Sacramento and San Francisco Counties		2		2			2									https://www.shop.anthem.com/medicare	https://www.shop.anthem.com/medicare	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			
H4161	005	0	1	01	01	H4161_005_0	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:56:39 PM Pacific Daylight Time	08/04/2022 03:16:23 PM Pacific Daylight Time	08/04/2022 03:29:18 PM Pacific Daylight Time			08/04/2022 07:03:00 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Anthem Blue Cross Partnership Plan	https://shop.anthem.com/medicare	Anthem MediBlue Prime (HMO)	01	01		1			H4161	005	0	2023	San Mateo County		2		2			2									https://www.shop.anthem.com/medicare	https://www.shop.anthem.com/medicare	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			
H4161	006	0	1	01	01	H4161_006_0	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:59:35 PM Pacific Daylight Time	08/04/2022 03:16:24 PM Pacific Daylight Time	08/04/2022 03:29:21 PM Pacific Daylight Time			08/04/2022 07:03:00 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Anthem Blue Cross Partnership Plan	https://shop.anthem.com/medicare	Anthem MediBlue Prime (HMO)	01	01		1			H4161	006	0	2023	Fresno County		2		2			2									https://www.shop.anthem.com/medicare	https://www.shop.anthem.com/medicare	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			
H4161	007	0	1	01	01	H4161_007_0	5	1			2		0	07/08/2022	2023.01	07/08/2022 10:41:01 AM Pacific Daylight Time	08/04/2022 03:16:25 PM Pacific Daylight Time	08/04/2022 03:29:24 PM Pacific Daylight Time			08/04/2022 07:03:00 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Anthem Blue Cross Partnership Plan	https://shop.anthem.com/medicare	Anthem MediBlue Prime (HMO)	01	01		1			H4161	007	0	2023	Ventura County		2		2			2									https://www.shop.anthem.com/medicare	https://www.shop.anthem.com/medicare	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			
H4172	001	0	1	01	01	H4172_001_0	5	1		1				08/03/2022	2023.01	08/03/2022 03:24:48 PM Central Daylight Time	08/03/2022 04:59:54 PM Central Daylight Time	08/02/2022 11:18:05 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	NHC ADVANTAGE, LLC	NHC Advantage	www.nhcadvantageplan.com	NHC Advantage (HMO I-SNP)	01	01		1			H4172	001	0	2023	MO (partial) TN (partial) SC (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						06/01/2022	2023.01	06/01/2022 01:27:35 PM Pacific Daylight Time		06/01/2022 01:49:24 PM Pacific Daylight Time			06/01/2022 01:50:19 PM Pacific Daylight Time	NEIGHBORHOOD HEALTHCARE	Neighborhood Healthcare PACE	www.nhcarepace.org	Neighborhood Healthcare PACE Dual Eligible (PACE)	08	20		1			H4185	001	0	2023	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						06/01/2022	2023.01	06/01/2022 01:28:01 PM Pacific Daylight Time		06/01/2022 01:49:24 PM Pacific Daylight Time			06/01/2022 01:50:19 PM Pacific Daylight Time	NEIGHBORHOOD HEALTHCARE	Neighborhood Healthcare PACE	www.nhcarepace.org	Neighborhood Healthcare PACE Medicare Only (PACE)	08	20		1			H4185	002	0	2023	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	4	1				0	0	07/13/2022	2023.01	07/13/2022 02:46:02 PM Central Daylight Time	06/06/2022 01:44:44 PM Central Daylight Time				07/14/2022 07:46:21 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Integris Health Partners+ (HMO)	www.ccokadvantage.com/2023/Integris	Integris Health Partners+ Choice (HMO)	01	01		1			H4198	007	0	2023	Select Oklahoma counties		2		2			2									www.ccokadvantage.com/2023/Integris/Pharmacy-and-Rx-Info,asp	www.medicareplanrx.com/jccf/ccok_amp_formulary_23.html	www.ccokadvantage.com/2023/Integris	(833)751-1141		(405)810-2008		(833)751-1141		(405)810-2008										(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	5	1					1	08/04/2022	2023.01	08/04/2022 04:13:56 PM Central Daylight Time	08/05/2022 06:49:20 AM Central Daylight Time	08/05/2022 06:49:21 AM Central Daylight Time			08/05/2022 06:55:49 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Integris Health Partners+ (HMO)	www.ccokadvantage.com/2023/Integris	Integris Health Partners+ Deluxe (HMO)	01	01		1			H4198	008	0	2023	Select Oklahoma counties		2		2			2									www.ccokadvantage.com/2023/Integris/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_amp_formulary_23.html	www.ccokadvantage.com/2023/Integris	(833)751-1141		(405)810-2008		(833)751-1141		(405)810-2008		(833)685-2861		(405)286-1970		(833)751-1141		(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	5	1					1	08/04/2022	2023.01	08/04/2022 04:14:13 PM Central Daylight Time	08/05/2022 06:49:20 AM Central Daylight Time	08/05/2022 06:49:21 AM Central Daylight Time			08/05/2022 06:55:49 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Integris Health Partners+ (HMO)	www.ccokadvantage.com/2023/Integris	Integris Health Partners+ Premier (HMO)	01	01		1			H4198	009	0	2023	Select Oklahoma counties		2		2			2									www.ccokadvantage.com/2023/Integris/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_amp_formulary_23.html	www.ccokadvantage.com/2023/Integris	(833)751-1141		(405)810-2008		(833)751-1141		(405)810-2008		(833)685-2861		(405)286-1970		(833)751-1141		(405)810-2008		(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	803	0	1	01	01	H4198_803_0	2	1						06/04/2022	2023.01	06/04/2022 06:52:38 AM Central Daylight Time					06/06/2022 01:46:43 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Integris Health Partners+ (HMO)	www.ccokadvantage.com/2023/Integris	Integris Health Plan EGWP (HMO)	01	01		1			H4198	803	0	2023	Select Oklahoma counties		1	200	2			2									www.ccokadvantage.com/2023/Integris/Pharmacy-and-Rx-Info,asp	www.medicareplanrx.com/jccf/ccok_amp_formulary_23.html	www.ccokadvantage.com/2023/Integris	(833)751-1141		(405)810-2008		(833)751-1141		(405)810-2008		(833)685-2861		(405)286-1970		(833)751-1141		(405)810-2008		(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;7c;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;10a;11a;12;14a;14d;14e2;15;16b;	1	5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;12;14a;14d;14e2;16b;	1					1				
H4203	001	0	1	20	08	H4203_001_0	1	1						06/01/2022	2023.01	06/01/2022 01:13:18 PM Eastern Daylight Time		06/01/2022 01:04:30 PM Eastern Daylight Time			06/01/2022 01:16:16 PM Eastern Daylight Time	PRISMA HEALTH-MIDLANDS	Prisma Health SeniorCare PACE-Midlands	www.prismahealth.org	Prisma Health PACE-Midlands - Dual Eligible (PACE)	08	20		1			H4203	001	0	2023	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						06/01/2022	2023.01	06/01/2022 01:13:58 PM Eastern Daylight Time		06/01/2022 01:04:22 PM Eastern Daylight Time			06/01/2022 01:16:16 PM Eastern Daylight Time	PRISMA HEALTH-MIDLANDS	Prisma Health SeniorCare PACE-Midlands	www.prismahealth.org	Prisma Health PACE-Midlands - Medicare Only (PACE)	08	20		1			H4203	002	0	2023	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	2	1				0	0	07/12/2022	2023.01	07/12/2022 02:42:23 PM Central Daylight Time	06/03/2022 04:57:19 PM Central Daylight Time				07/12/2022 03:19:03 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	2023	State of Arkansas	Northern, Western and South Central AR counties	2		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	2	1				0	0	07/12/2022	2023.01	07/12/2022 02:44:42 PM Central Daylight Time	06/03/2022 04:57:25 PM Central Daylight Time				07/12/2022 03:19:03 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	2023	State of Arkansas	Northwest, Western and Central AR counties	2		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	2	1				0	0	07/12/2022	2023.01	07/12/2022 02:46:32 PM Central Daylight Time	06/03/2022 04:57:30 PM Central Daylight Time				07/12/2022 03:19:03 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	2023	State of Arkansas	East Central AR counties	2		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	3	1						07/12/2022	2023.01	07/12/2022 02:48:33 PM Central Daylight Time	08/04/2022 01:08:05 PM Central Daylight Time	08/04/2022 01:08:10 PM Central Daylight Time			08/04/2022 01:42:16 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	2023	State of Arkansas	Northern, Western and South Central AR counties	2		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	3	1						07/12/2022	2023.01	07/12/2022 02:50:37 PM Central Daylight Time	08/04/2022 01:08:16 PM Central Daylight Time	08/04/2022 01:08:21 PM Central Daylight Time			08/04/2022 01:42:16 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	2023	State of Arkansas	Northwest, Western and Central AR counties	2		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	3	1						07/12/2022	2023.01	07/12/2022 02:53:17 PM Central Daylight Time	08/04/2022 01:08:27 PM Central Daylight Time	08/04/2022 01:08:32 PM Central Daylight Time			08/04/2022 01:42:16 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	2023	State of Arkansas	East Central AR counties	2		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	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 11:12:30 AM Eastern Daylight Time	08/04/2022 11:08:03 AM Eastern Daylight Time	08/04/2022 11:08:03 AM Eastern Daylight Time			08/04/2022 11:14:44 AM Eastern 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	2023	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	08/03/2022	2023.01	08/03/2022 02:14:18 PM Eastern Daylight Time	08/04/2022 11:08:03 AM Eastern Daylight Time	08/04/2022 11:08:03 AM Eastern Daylight Time			08/04/2022 11:14:44 AM Eastern 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	2023	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	5	1		1				08/02/2022	2023.01	08/02/2022 12:04:37 PM Central Daylight Time	08/01/2022 10:55:25 PM Central Daylight Time	07/29/2022 05:37:28 PM Central Daylight Time			08/03/2022 09:32:37 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	2023	North and Central 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	1	01	7c;7i;	
H4232	002	0	1	01	01	H4232_002_0	4	1		1				08/02/2022	2023.01	08/02/2022 12:05:37 PM Central Daylight Time	08/01/2022 10:57:35 PM Central Daylight Time	07/29/2022 05:36:29 PM Central Daylight Time			08/03/2022 09:32:37 AM Central Daylight Time	AMERICAN HEALTH PLAN OF UT, INC.	American Health Advantage of Utah	ut.amhealthplans.com	American Health Advantage of Utah Premier (HMO I-SNP)	01	01		1			H4232	002	0	2023	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	7	1		1				08/02/2022	2023.01	08/02/2022 12:06:10 PM Central Daylight Time	08/01/2022 10:58:43 PM Central Daylight Time	07/29/2022 05:35:49 PM Central Daylight Time			08/03/2022 09:32:37 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	2023	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	1	01	7c;7i;	
H4235	001	0	1	20	08	H4235_001_0	1	1						06/02/2022	2023.01	06/02/2022 12:13:00 PM Eastern Daylight Time		06/02/2022 01:38:28 PM Eastern Daylight Time			06/02/2022 01:41:06 PM Eastern Daylight Time	SENIOR TOTAL LIFE CARE, INC.	Senior Total Life Care	www.seniorTLC.org	Senior Total Life Care Dual (PACE)	08	20		1			H4235	001	0	2023	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						06/02/2022	2023.01	06/02/2022 12:13:13 PM Eastern Daylight Time		06/02/2022 01:38:28 PM Eastern Daylight Time			06/02/2022 01:41:06 PM Eastern Daylight Time	SENIOR TOTAL LIFE CARE, INC.	Senior Total Life Care	www.seniorTLC.org	Senior Total Life Care Medicare (PACE)	08	20		1			H4235	002	0	2023	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						06/01/2022	2023.01	06/01/2022 12:10:45 PM Eastern Daylight Time		05/31/2022 09:23:01 AM Eastern Daylight Time			06/01/2022 01:11:13 PM Eastern Daylight Time	PACE NORTH, INC.	PACE North	www.pacenorth.org	PACE North, Inc (PACE)	08	20		1			H4256	001	0	2023	Grand Traverse, Benz, Leel,Wexf, Kalk, Antr, Mani		2		2			2									HomeTownPharmacy.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						06/01/2022	2023.01	06/01/2022 12:11:05 PM Eastern Daylight Time		05/31/2022 09:23:01 AM Eastern Daylight Time			06/01/2022 01:11:13 PM Eastern Daylight Time	PACE NORTH, INC.	PACE North	www.pacenorth.org	PACE North, Inc (PACE)	08	20		1			H4256	002	0	2023	Grand Traverse, Benz, Leel,Wexf, Kalk, Antr, Mani		2		2			2									HomeTownPharmacy.com	N/A												(231)252-2767				(231)252-2767												(833)410-2082				(833)410-2082																
H4277	001	0	1	04	01	H4277_001_0	7	1					1	08/04/2022	2023.01	08/04/2022 04:11:57 PM Central Daylight Time	08/05/2022 06:49:21 AM Central Daylight Time	08/05/2022 06:49:21 AM Central Daylight Time			08/05/2022 06:58:37 AM Central Daylight Time	CommunityCare Life & Health Insurance Co.	CommunityCare Options (PPO)	www.ccok.com	Gold (PPO)	01	04		1			H4277	001	0	2023	Select counties in N.E. Oklahoma		2		2			2									www.ccok.com/2023/PPO/Pharmacy-and-Rx-Info,asp	www.medicareplanrx.com/jccf/ccok_PPO_formulary_23.html	www.ccok.com	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202		(877)293-8628		(918)594-5211		(800)333-3275		(918)594-5202		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2						2			
H4279	001	0	1	01	01	H4279_001_0	6	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 07:07:30 AM Eastern Daylight Time	08/05/2022 12:22:55 AM Eastern Daylight Time	08/05/2022 12:23:36 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Western, Central, and North Eastern Pennsylvania		2		2			1	3		1					1	https://www.upmchealthplan.com/snp/learn/plan-benefits/prescription-drug-coverage/	https://www.upmchealthplan.com/snp/learn/plan-benefits/prescription-drug-coverage/	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	1		0	08/04/2022	2023.01	08/04/2022 07:10:01 AM Eastern Daylight Time	08/05/2022 12:22:57 AM Eastern Daylight Time	08/05/2022 12:23:36 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Eastern Pennsylvania		2		2			1	3		1					1	https://www.upmchealthplan.com/snp/learn/plan-benefits/prescription-drug-coverage/	https://www.upmchealthplan.com/snp/learn/plan-benefits/prescription-drug-coverage/	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	10	1					1	08/04/2022	2023.01	08/04/2022 04:49:07 PM India Standard Time	08/04/2022 10:54:48 AM Central Daylight Time	08/01/2022 11:32:41 AM Central Daylight Time			08/04/2022 01:01:01 PM Central Daylight Time	LEON HEALTH, INC.	Leon Health Plans	www.leonhealth.com	Leon MediExtra (HMO)	01	01		1			H4286	001	0	2023	Leon MediExtra Miami Dade		2		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	14	1	2	1			0	08/04/2022	2023.01	08/04/2022 04:50:07 PM India Standard Time	08/04/2022 10:56:05 AM Central Daylight Time	08/01/2022 11:26:40 AM Central Daylight Time			08/04/2022 01:01:01 PM Central Daylight Time	LEON HEALTH, INC.	Leon Health Plans	www.leonhealth.com	Leon MediDual (HMO D-SNP)	01	01		1			H4286	002	0	2023	Leon MediDual Miami Dade		2		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	9	1					0	08/04/2022	2023.01	08/04/2022 04:51:00 PM India Standard Time	08/04/2022 10:59:07 AM Central Daylight Time	08/04/2022 12:55:09 PM Central Daylight Time			08/04/2022 01:01:01 PM Central Daylight Time	LEON HEALTH, INC.	Leon Health Plans	www.leonhealth.com	Leon MediMore (HMO)	01	01		1			H4286	003	0	2023	Leon MediMore Miami Dade		2		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	6	1					1	08/04/2022	2023.01	08/04/2022 08:13:15 PM Mountain Daylight Time	08/05/2022 01:42:36 PM Mountain Daylight Time	08/05/2022 01:42:43 PM Mountain Daylight Time			08/05/2022 02:01:55 PM Mountain Daylight Time	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	University of Utah Health Insurance Plans	www.AdvantageUMedicare.com	Advantage U Signature (PPO)	01	04		1			H4304	001	0	2023	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	002	0	1	04	01	H4304_002_0	6	1					0	08/04/2022	2023.01	08/04/2022 08:06:16 PM Mountain Daylight Time	08/05/2022 01:42:50 PM Mountain Daylight Time	08/05/2022 01:42:58 PM Mountain Daylight Time			08/05/2022 02:01:55 PM Mountain Daylight Time	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	University of Utah Health Insurance Plans	www.AdvantageUMedicare.com	Advantage U Signature Part B buyback (PPO)	01	04		1			H4304	002	0	2023	Davis, Salt Lake, Tooele, Utah, 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	4	1						07/19/2022	2023.01	07/19/2022 10:52:20 AM Mountain Daylight Time					07/19/2022 01:26:32 PM Mountain Daylight Time	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	University of Utah Health Insurance Plans	www.AdvantageUMedicare.com	Advantage U CY EWGP (PPO)	01	04		1			H4304	801	0	2023	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		(888)970-0851		(888)970-0851		(855)275-0374		(855)275-0374		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4304	802	0	1	04	01	H4304_802_0	4	1						07/20/2022	2023.01	07/20/2022 12:01:28 PM Mountain Daylight Time					07/20/2022 12:10:07 PM Mountain Daylight Time	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	University of Utah Health Insurance Plans	www.AdvantageUMedicare.com	Advantage U BY EWGP (PPO)	01	04		1			H4304	802	0	2023	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		(888)970-0851		(888)970-0851		(855)275-0374		(855)275-0374		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4304	803	0	1	04	01	H4304_803_0	5	1				0	0	07/20/2022	2023.01	07/20/2022 12:03:15 PM Mountain Daylight Time					07/20/2022 12:10:07 PM Mountain Daylight Time	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	University of Utah Health Insurance Plans	www.AdvantageUMedicare.com	Advantage U EWGP MA ONLY (PPO)	01	04		1			H4304	803	0	2023	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)-										2					2						2			
H4305	001	0	1	20	08	H4305_001_0	1	1						06/01/2022	2023.01	06/01/2022 10:09:34 AM Central Daylight Time		06/02/2022 07:20:18 AM Central Daylight Time			06/02/2022 08:43:35 AM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	www.stbernards.info/	Total Life Healthcare Dual (PACE)	08	20		1			H4305	001	0	2023	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)207-0571		(000)000-0000		(870)207-0527																
H4305	002	0	1	20	08	H4305_002_0	1	1						06/01/2022	2023.01	06/01/2022 10:10:30 AM Central Daylight Time		06/02/2022 07:20:18 AM Central Daylight Time			06/02/2022 08:43:35 AM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	www.stbernards.info/	Total Life Healthcare Medicare only (PACE)	08	20		1			H4305	002	0	2023	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)207-0571		(000)000-0000		(870)207-0527																
H4326	001	0	1	20	08	H4326_001_0	1	1						06/03/2022	2023.01	06/03/2022 04:17:51 PM Eastern Daylight Time		06/03/2022 04:14:34 PM Eastern Daylight Time			06/03/2022 04:20:12 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	2023	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						06/03/2022	2023.01	06/03/2022 04:18:08 PM Eastern Daylight Time		06/03/2022 04:14:45 PM Eastern Daylight Time			06/03/2022 04:20:12 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	2023	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	5	1						08/01/2022	2023.01	08/01/2022 12:41:13 PM Central Daylight Time	08/03/2022 08:38:27 PM Eastern Daylight Time	07/30/2022 09:11:19 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent's Reward (HMO)	01	01		1			H4343	001	0	2023	Birmingham & Surrounding Counties in Alabama		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	002	0	1	01	01	H4343_002_0	5	1						08/01/2022	2023.01	08/01/2022 12:42:26 PM Central Daylight Time	08/03/2022 08:39:42 PM Eastern Daylight Time	07/30/2022 09:11:51 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Providence Reward (HMO)	01	01		1			H4343	002	0	2023	Mobile area in Alabama		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	003	0	1	01	01	H4343_003_0	5	1						08/01/2022	2023.01	08/01/2022 12:43:18 PM Central Daylight Time	08/03/2022 08:40:56 PM Eastern Daylight Time	07/30/2022 09:12:23 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent's Secure (HMO)	01	01		1			H4343	003	0	2023	Birmingham surrounding counties in Alabama		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	004	0	1	01	01	H4343_004_0	5	1						08/01/2022	2023.01	08/01/2022 12:44:07 PM Central Daylight Time	08/03/2022 08:42:11 PM Eastern Daylight Time	07/30/2022 09:12:53 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Providence Secure (HMO)	01	01		1			H4343	004	0	2023	Mobile area in Alabama		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	005	0	1	01	01	H4343_005_0	5	1	2	1			0	07/15/2022	2023.01	07/15/2022 08:33:21 AM Central Daylight Time	08/03/2022 08:43:28 PM Eastern Daylight Time	07/30/2022 09:13:26 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent's DSNP (HMO D-SNP)	01	01		1			H4343	005	0	2023	Birmingham & Surrounding  Counties in Alabama		2		2			1	3		1					1	www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	006	0	1	01	01	H4343_006_0	6	1	2	1			0	07/15/2022	2023.01	07/15/2022 08:34:53 AM Central Daylight Time	08/03/2022 08:44:46 PM Eastern Daylight Time	07/30/2022 09:13:58 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Providence DSNP (HMO D-SNP)	01	01		1			H4343	006	0	2023	Mobile area in Alabama		2		2			1	3		1					1	www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	001	0	1	01	01	H4346_001_0	5	1			2		0	08/01/2022	2023.01	08/01/2022 05:13:15 PM Eastern Daylight Time	08/04/2022 06:23:15 PM Eastern Daylight Time	08/04/2022 06:42:24 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	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	5	1		1	2		0	08/03/2022	2023.01	08/03/2022 12:16:18 PM Eastern Daylight Time	08/04/2022 06:23:16 PM Eastern Daylight Time	08/04/2022 06:42:26 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	Clark County		2		2			1	4			00000000000100000000000					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	5	1		1	2		1	08/03/2022	2023.01	08/03/2022 12:16:31 PM Eastern Daylight Time	08/04/2022 06:23:18 PM Eastern Daylight Time	08/04/2022 06:42:29 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	Clark County		2		2			1	4			00000010000000000000000					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	2		0	08/01/2022	2023.01	08/01/2022 05:17:37 PM Eastern Daylight Time	08/04/2022 06:23:19 PM Eastern Daylight Time	08/04/2022 06:42:32 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	Clark County		2		2			1	4			00000000000000000010000					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	5	1			2		0	08/01/2022	2023.01	08/01/2022 05:18:01 PM Eastern Daylight Time	08/04/2022 06:23:21 PM Eastern Daylight Time	08/04/2022 06:42:34 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	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	5	1		1	2		0	08/01/2022	2023.01	08/01/2022 05:18:14 PM Eastern Daylight Time	08/04/2022 06:23:22 PM Eastern Daylight Time	08/04/2022 06:42:37 PM Eastern Daylight Time			08/04/2022 08:16:16 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	2023	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	5	1			2		0	07/14/2022	2023.01	07/14/2022 01:31:13 PM Pacific Daylight Time	08/04/2022 03:20:03 PM Pacific Daylight Time	08/04/2022 03:36:17 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:22:32 AM Eastern Daylight Time	08/04/2022 06:15:24 PM Eastern Daylight Time	08/04/2022 06:27:26 PM Eastern Daylight Time			08/04/2022 07:52:55 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	014	0	2023	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	5	1			2		0	08/02/2022	2023.01	08/02/2022 12:45:49 AM Pacific Daylight Time	08/04/2022 03:20:04 PM Pacific Daylight Time	08/04/2022 03:36:20 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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	5	1			2		0	08/02/2022	2023.01	08/02/2022 12:48:18 AM Pacific Daylight Time	08/04/2022 03:20:06 PM Pacific Daylight Time	08/04/2022 03:36:22 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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)341-4606		(833)341-4606		(855)485-0962		(855)485-0962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	024	0	1	01	01	H4346_024_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 12:49:17 AM Pacific Daylight Time	08/04/2022 03:20:07 PM Pacific Daylight Time	08/04/2022 03:36:25 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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)341-4605		(833)341-4605		(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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:23:57 AM Eastern Daylight Time	08/04/2022 06:15:25 PM Eastern Daylight Time	08/04/2022 06:27:29 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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)341-4606		(833)341-4606		(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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 12:41:58 PM Eastern Daylight Time	08/04/2022 06:15:27 PM Eastern Daylight Time	08/04/2022 06:27:31 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	Clark County		2		2			1	3		1					1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)679-0549		(855)679-0549		(833)341-4604		(833)341-4604		(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	6	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:31:53 PM Pacific Daylight Time		08/04/2022 03:36:28 PM Pacific Daylight Time		08/04/2022 03:20:08 PM Pacific Daylight Time	08/19/2022 08:29:30 AM 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	2023	Select Counties in CO		2		2			1	4			00000000100000000000000					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	2	1						05/23/2022	2023.01	05/23/2022 02:11:02 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;11c;15;16b;18a;	2		1					1				
H4346	805	0	1	01	01	H4346_805_0	2	1						05/20/2022	2023.01	05/20/2022 12:11:16 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	806	0	2	01	01	H4346_806_0	2	1						05/20/2022	2023.01	05/20/2022 12:11:37 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	809	0	1	01	01	H4346_809_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 12:12:43 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	810	0	2	01	01	H4346_810_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 12:13:08 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	812	0	1	01	01	H4346_812_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 12:13:29 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	821	0	2	01	01	H4346_821_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 12:14:05 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	823	0	1	01	01	H4346_823_0	2	1						05/20/2022	2023.01	05/20/2022 12:30:59 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	824	0	1	01	01	H4346_824_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 12:31:27 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	826	0	1	01	01	H4346_826_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 12:33:04 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	827	0	2	01	01	H4346_827_0	2	1						05/20/2022	2023.01	05/20/2022 12:35:45 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	828	0	2	01	01	H4346_828_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 12:36:11 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4346	830	0	2	01	01	H4346_830_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 12:36:31 PM Pacific Daylight Time					06/03/2022 10:58:52 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H4393	001	0	1	20	08	H4393_001_0	1	1						06/03/2022	2023.01	06/03/2022 03:04:51 PM Eastern Daylight Time		05/27/2022 04:01:20 PM Eastern Daylight Time			06/03/2022 03:07:18 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 03:05:20 PM Eastern Daylight Time		05/27/2022 04:03:08 PM Eastern Daylight Time			06/03/2022 03:07:18 PM 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	2023	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						06/01/2022	2023.01	06/01/2022 12:19:34 PM Central Daylight Time		05/27/2022 10:14:01 AM Central Daylight Time			06/01/2022 12:21:07 PM Central Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	www.ascensionliving.org/alexianpace	Alexian Brothers Community Services (PACE)	08	20		1			H4402	001	0	2023	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						06/01/2022	2023.01	06/01/2022 12:19:44 PM Central Daylight Time		05/27/2022 10:14:11 AM Central Daylight Time			06/01/2022 12:21:07 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	2023	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	4	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:53:59 AM Central Daylight Time	08/02/2022 02:16:52 PM Central Daylight Time	08/01/2022 10:40:09 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4407	004	0	2023	South Mississippi		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	011	0	1	01	01	H4407_011_0	2	1				0	0	05/28/2022	2023.01	05/28/2022 12:03:16 PM Central Daylight Time	05/31/2022 12:35:02 PM Central Daylight Time				06/02/2022 08:40:51 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H4407	011	0	2023	South Mississippi		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4407	026	0	1	01	01	H4407_026_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:24:13 PM Central Daylight Time	08/02/2022 03:18:24 PM Central Daylight Time	08/01/2022 10:40:41 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4407	026	0	2023	South Mississippi		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(855)980-3032		(855)980-3032		(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		1	05/15/2022	2023.01	05/15/2022 08:49:41 AM Central Daylight Time	08/02/2022 03:25:10 PM Central Daylight Time	08/01/2022 10:41:12 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H4407	027	0	2023	South Mississippi		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	028	0	1	01	01	H4407_028_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:17:26 PM Central Daylight Time	08/02/2022 12:39:06 PM Central Daylight Time	08/01/2022 10:41:43 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4407	028	0	2023	North Mississippi		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	029	0	1	01	01	H4407_029_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 09:52:10 PM Central Daylight Time	08/02/2022 03:28:35 PM Central Daylight Time	08/01/2022 10:42:15 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H4407	029	0	2023	South Mississippi		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	004	0	1	01	01	H4461_004_0	2	1			2	0	0	05/28/2022	2023.01	05/28/2022 09:27:54 AM Eastern Daylight Time	07/18/2022 04:47:12 PM Eastern Daylight Time				07/20/2022 02:05:39 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H4461	004	0	2023	Greater Tennessee		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4461	022	0	1	01	01	H4461_022_0	4	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 05:43:58 PM Eastern Daylight Time	08/03/2022 03:38:53 PM Eastern Daylight Time	07/30/2022 06:41:32 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	Greater Tennessee		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 01:34:39 PM Eastern Daylight Time	08/03/2022 03:37:24 PM Eastern Daylight Time	07/30/2022 06:41:56 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	Memphis Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 01:35:45 PM Eastern Daylight Time	08/03/2022 03:40:02 PM Eastern Daylight Time	07/30/2022 06:42:20 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	Nashville Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/28/2022	2023.01	05/28/2022 09:30:50 AM Eastern Daylight Time	08/03/2022 03:41:07 PM Eastern Daylight Time	07/30/2022 06:42:44 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	East Tennessee	East Tennessee	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 11:33:09 AM Eastern Daylight Time	08/03/2022 03:42:15 PM Eastern Daylight Time	07/30/2022 06:43:08 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	East Tennessee	East Tennessee	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 11:38:29 AM Eastern Daylight Time	08/03/2022 03:43:20 PM Eastern Daylight Time	07/30/2022 06:43:34 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	East Tennessee	East Tennessee	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 01:36:31 PM Eastern Daylight Time	08/03/2022 03:44:24 PM Eastern Daylight Time	07/30/2022 06:43:58 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	East Tennessee	East Tennessee	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 11:43:02 AM Eastern Daylight Time	08/03/2022 03:45:32 PM Eastern Daylight Time	07/30/2022 06:44:24 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	East Tennessee	East Tennessee	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 11:44:13 AM Eastern Daylight Time	08/03/2022 03:46:38 PM Eastern Daylight Time	07/30/2022 06:44:48 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	East Tennessee	East Tennessee	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 01:08:26 PM Eastern Daylight Time	08/03/2022 03:48:45 PM Eastern Daylight Time	07/30/2022 06:45:12 AM Eastern Daylight Time			08/04/2022 12:04:28 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	2023	East Tennessee		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 01:08:44 PM Eastern Daylight Time	08/03/2022 04:03:57 PM Eastern Daylight Time	07/30/2022 06:45:38 AM Eastern Daylight Time			08/04/2022 12:04:28 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	2023	East Tennessee		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 01:09:10 PM Eastern Daylight Time	08/03/2022 04:05:00 PM Eastern Daylight Time	07/30/2022 06:46:02 AM Eastern Daylight Time			08/04/2022 12:04:28 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	2023	East Tennessee		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 01:09:23 PM Eastern Daylight Time	08/03/2022 04:14:13 PM Eastern Daylight Time	07/30/2022 06:46:28 AM Eastern Daylight Time			08/04/2022 12:04:28 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	2023	Rural Tennessee		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/28/2022	2023.01	05/28/2022 09:19:57 AM Eastern Daylight Time	08/03/2022 04:18:50 PM Eastern Daylight Time	07/30/2022 06:46:52 AM Eastern Daylight Time			08/04/2022 12:04:28 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	2023	Greater Tennessee		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	039	0	1	01	01	H4461_039_0	3	1			2		1	05/28/2022	2023.01	05/28/2022 09:20:14 AM Eastern Daylight Time	08/03/2022 04:23:45 PM Eastern Daylight Time	07/30/2022 06:47:18 AM Eastern Daylight Time			08/04/2022 12:04:28 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-039 (HMO)	01	01		1			H4461	039	0	2023	Nashville		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/27/2022	2023.01	05/27/2022 05:53:13 PM Eastern Daylight Time					05/27/2022 06:00:02 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	806	0	2023	Select counties in East Tennessee area		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 05:54:51 PM Eastern Daylight Time					05/27/2022 06:00:02 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	807	0	2023	Select counties in East Tennessee area		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/27/2022	2023.01	05/27/2022 05:57:30 PM Eastern Daylight Time					05/27/2022 06:00:02 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	810	0	2023	Select counties in East Tennessee area		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 05:59:41 PM Eastern Daylight Time					05/27/2022 06:00:02 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	811	0	2023	Select counties in East Tennessee area		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	5	1		1				08/02/2022	2023.01	08/02/2022 12:06:50 PM Central Daylight Time	08/01/2022 10:59:36 PM Central Daylight Time	07/29/2022 05:35:25 PM Central Daylight Time			08/03/2022 09:32:37 AM Central Daylight Time	AMERICAN HEALTH PLAN OF MISSOURI, INC.	American Health Advantage of Missouri	mo.AmHealthPlans.com	American Health Advantage of Missouri (HMO I-SNP)	01	01		1			H4490	001	0	2023	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	1	01	7c;7i;	
H4490	002	0	1	01	01	H4490_002_0	4	1		1				08/02/2022	2023.01	08/02/2022 12:07:38 PM Central Daylight Time	08/01/2022 11:02:21 PM Central Daylight Time	07/29/2022 05:34:33 PM Central Daylight Time			08/03/2022 09:32:37 AM Central Daylight Time	AMERICAN HEALTH PLAN OF MISSOURI, INC.	American Health Advantage of Missouri	mo.AmHealthPlans.com	American Health Advantage of Missouri Premier (HMO I-SNP)	01	01		1			H4490	002	0	2023	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	5	1		1				08/03/2022	2023.01	08/03/2022 09:22:58 AM Central Daylight Time	08/01/2022 11:03:28 PM Central Daylight Time	07/29/2022 05:34:03 PM Central Daylight Time			08/03/2022 09:32:37 AM Central Daylight Time	AMERICAN HEALTH PLAN OF MISSOURI, INC.	American Health Advantage of Missouri	mo.AmHealthPlans.com	American Health Advantage of Missouri Choice (HMO I-SNP)	01	01		1			H4490	003	0	2023	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	1	01	7c;7i;	
H4497	001	1	1	04	01	H4497_001_1	14	1						08/04/2022	2023.01	08/04/2022 11:16:24 AM Eastern Daylight Time	08/03/2022 12:14:54 PM Eastern Daylight Time	08/02/2022 03:15:50 PM Eastern Daylight Time			08/05/2022 04:44:40 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	1	2023	Ohio Regions	Northeast Ohio	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	001	2	1	04	01	H4497_001_2	14	1						08/04/2022	2023.01	08/04/2022 11:16:39 AM Eastern Daylight Time	08/03/2022 12:15:38 PM Eastern Daylight Time	08/02/2022 03:16:14 PM Eastern Daylight Time			08/05/2022 04:44:40 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	2	2023	Ohio Regions	Select Ohio Counties	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	001	3	1	04	01	H4497_001_3	14	1						08/04/2022	2023.01	08/04/2022 11:16:55 AM Eastern Daylight Time	08/03/2022 12:16:22 PM Eastern Daylight Time	08/02/2022 03:16:38 PM Eastern Daylight Time			08/05/2022 04:44:40 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	3	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	1	1	04	01	H4497_002_1	15	1						08/16/2022	2023.01	08/16/2022 12:46:55 PM Eastern Daylight Time	08/03/2022 12:17:06 PM Eastern Daylight Time	08/02/2022 03:17:30 PM Eastern Daylight Time			08/16/2022 01:30:13 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	1	2023	Ohio Regions	Northeast Ohio	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	2	1	04	01	H4497_002_2	14	1						08/04/2022	2023.01	08/04/2022 11:09:13 AM Eastern Daylight Time	08/03/2022 12:17:56 PM Eastern Daylight Time	08/02/2022 03:17:56 PM Eastern Daylight Time			08/05/2022 04:44:40 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	2	2023	Ohio Regions	Select Ohio Counties	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	3	1	04	01	H4497_002_3	14	1						08/04/2022	2023.01	08/04/2022 11:20:30 AM Eastern Daylight Time	08/03/2022 12:18:40 PM Eastern Daylight Time	08/02/2022 03:18:22 PM Eastern Daylight Time			08/05/2022 04:44:40 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	3	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	1	1	04	01	H4497_003_1	15	1						08/04/2022	2023.01	08/04/2022 11:14:07 AM Eastern Daylight Time	08/03/2022 12:19:22 PM Eastern Daylight Time	08/02/2022 03:18:48 PM Eastern Daylight Time			08/05/2022 04:44:40 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	1	2023	Ohio Regions	Northeast Ohio	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	2	1	04	01	H4497_003_2	15	1						08/04/2022	2023.01	08/04/2022 11:15:09 AM Eastern Daylight Time	08/03/2022 12:20:06 PM Eastern Daylight Time	08/02/2022 03:19:14 PM Eastern Daylight Time			08/05/2022 04:44:40 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	2	2023	Ohio Regions	Select Ohio Counties	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	3	1	04	01	H4497_003_3	15	1						08/04/2022	2023.01	08/04/2022 11:16:07 AM Eastern Daylight Time	08/03/2022 12:20:50 PM Eastern Daylight Time	08/02/2022 03:19:40 PM Eastern Daylight Time			08/05/2022 04:44:40 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	3	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	005	1	1	04	01	H4497_005_1	14	1						08/04/2022	2023.01	08/04/2022 04:06:17 PM Eastern Daylight Time	08/03/2022 12:21:34 PM Eastern Daylight Time	08/02/2022 03:20:06 PM Eastern Daylight Time			08/05/2022 04:44:40 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	2023	Ohio Regions	Northeast Ohio	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	005	2	1	04	01	H4497_005_2	14	1						08/04/2022	2023.01	08/04/2022 04:06:01 PM Eastern Daylight Time	08/03/2022 12:22:18 PM Eastern Daylight Time	08/02/2022 03:20:32 PM Eastern Daylight Time			08/05/2022 04:44:40 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Access (PPO)	01	04		1			H4497	005	2	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	801	0	1	04	01	H4497_801_0	8	1						05/10/2022	2023.01	05/10/2022 03:25:03 PM Eastern Daylight Time					06/06/2022 09:59:06 AM 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	2023	Ohio Regions		1	17600	2			2									medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(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	8	1						05/10/2022	2023.01	05/10/2022 03:33:35 PM Eastern Daylight Time					06/06/2022 09:59:06 AM 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	2023	Ohio Regions		1	100	2			2									medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(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	8	1				0	0	05/10/2022	2023.01	05/10/2022 03:35:42 PM Eastern Daylight Time					06/06/2022 09:59:06 AM 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	2023	Ohio Regions		1	100	2			2									medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823										(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	08/03/2022	2023.01	08/03/2022 02:31:49 PM Eastern Daylight Time	08/03/2022 08:22:17 PM Eastern Daylight Time	07/30/2022 09:14:29 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		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	3	1				0	0	05/26/2022	2023.01	05/26/2022 03:52:45 PM Pacific Daylight Time	06/03/2022 08:24:02 PM Eastern Daylight Time				07/15/2022 04:06:59 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus Patriot Giveback (HMO)	01	01		1			H4506	010	0	2023	Select counties in TX		2		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						08/01/2022	2023.01	08/01/2022 05:38:04 PM Eastern Daylight Time	08/03/2022 08:23:20 PM Eastern Daylight Time	07/30/2022 09:15:01 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		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	1	1						05/10/2022	2023.01	05/10/2022 11:15:39 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:15:43 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:15:47 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	H4506 - Retiree - MA (HMO)	01	01		1			H4506	808	0	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:15:52 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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				0	0	05/28/2022	2023.01	05/28/2022 04:53:02 PM Central Daylight Time	06/01/2022 02:48:53 PM Central Daylight Time				06/02/2022 08:40:51 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H4513	009	0	2023	Houston/Valley		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	026	0	1	01	01	H4513_026_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:51:36 PM Central Daylight Time	08/03/2022 08:52:53 AM Central Daylight Time	08/01/2022 10:42:46 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	026	0	2023	East Texas		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	027	0	1	01	01	H4513_027_0	4	1	2	1	1		0	05/28/2022	2023.01	05/28/2022 04:54:07 PM Central Daylight Time	08/03/2022 08:53:44 AM Central Daylight Time	08/01/2022 10:43:18 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	027	0	2023	East Texas		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	030	0	1	01	01	H4513_030_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:18:32 PM Central Daylight Time	08/02/2022 12:41:55 PM Central Daylight Time	08/01/2022 10:43:50 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	030	0	2023	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	2	1				0	0	05/12/2022	2023.01	05/12/2022 01:07:50 PM Central Daylight Time	05/31/2022 10:50:02 AM Central Daylight Time				06/02/2022 08:40:51 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H4513	033	0	2023	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	1		0	07/01/2022	2023.01	07/01/2022 11:01:20 AM Central Daylight Time	08/02/2022 12:42:42 PM Central Daylight Time	08/01/2022 10:44:22 AM Central Daylight Time			08/04/2022 02:09:36 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	2023	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						05/25/2022	2023.01	05/25/2022 11:29:59 AM Central Daylight Time	08/02/2022 12:43:33 PM Central Daylight Time	08/01/2022 10:44:54 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H4513	035	0	2023	Knoxville/Chattanooga		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	4	1			2		1	05/28/2022	2023.01	05/28/2022 11:30:54 AM Central Daylight Time	08/02/2022 02:57:26 PM Central Daylight Time	08/01/2022 10:45:25 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Premier Medicare (HMO-POS)	01	02		1			H4513	036	0	2023	Middle and 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	037	0	1	01	01	H4513_037_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:19:07 PM Central Daylight Time	08/02/2022 12:45:05 PM Central Daylight Time	08/01/2022 10:45:56 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	037	0	2023	Knoxville/Chattanooga		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		1	08/02/2022	2023.01	08/02/2022 08:19:54 PM Central Daylight Time	08/02/2022 12:45:48 PM Central Daylight Time	08/01/2022 10:46:27 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	038	0	2023	Jonesboro		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(877)363-5114		(877)363-5114		(800)668-3813		(800)668-3813		(877)363-5114		(877)363-5114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	039	0	1	01	01	H4513_039_0	4	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 10:52:19 AM Central Daylight Time	08/02/2022 12:46:38 PM Central Daylight Time	08/01/2022 10:47:00 AM Central Daylight Time			08/04/2022 02:09:36 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	2023	Jonesboro		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	1		0	07/01/2022	2023.01	07/01/2022 11:01:10 AM Central Daylight Time	08/02/2022 12:47:44 PM Central Daylight Time	08/01/2022 10:47:33 AM Central Daylight Time			08/04/2022 02:09:36 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	2023	Chattanooga		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	2	1				0	0	05/13/2022	2023.01	05/13/2022 10:30:45 AM Central Daylight Time	06/01/2022 03:11:56 PM Central Daylight Time				06/02/2022 08:40:51 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H4513	045	0	2023	Alabama		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	046	1	1	01	01	H4513_046_1	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:25:01 PM Central Daylight Time	08/02/2022 05:06:02 PM Central Daylight Time	08/01/2022 10:48:05 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred AL Medicare (HMO)	01	01		1			H4513	046	1	2023	Alabama	Birmingham/Mobile/Montgomery	2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	046	2	1	01	01	H4513_046_2	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:25:36 PM Central Daylight Time	08/02/2022 05:08:06 PM Central Daylight Time	08/01/2022 10:48:36 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred AL Medicare (HMO)	01	01		1			H4513	046	2	2023	Alabama	Huntsville	2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	047	0	1	01	01	H4513_047_0	4	1			2		1	05/18/2022	2023.01	05/18/2022 01:17:58 PM Central Daylight Time	08/02/2022 05:09:49 PM Central Daylight Time	08/01/2022 10:49:07 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H4513	047	0	2023	Birmingham/Mobile/Montgomery		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	048	0	1	01	01	H4513_048_0	4	1			2		1	05/15/2022	2023.01	05/15/2022 08:53:16 AM Central Daylight Time	08/02/2022 07:23:51 PM Central Daylight Time	08/01/2022 10:49:38 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H4513	048	0	2023	Huntsville		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(855)980-3032		(855)980-3032		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	049	1	1	01	01	H4513_049_1	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:20:32 PM Central Daylight Time	08/02/2022 12:48:37 PM Central Daylight Time	08/01/2022 10:50:09 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	049	1	2023	Tennessee	Nashville	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		1	08/02/2022	2023.01	08/02/2022 08:20:59 PM Central Daylight Time	08/02/2022 12:49:44 PM Central Daylight Time	08/01/2022 10:50:40 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	049	2	2023	Tennessee	Middle 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	049	3	1	01	01	H4513_049_3	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:21:42 PM Central Daylight Time	08/02/2022 12:51:33 PM Central Daylight Time	08/01/2022 10:51:11 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	049	3	2023	Tennessee	Chattanooga	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	4	1	01	01	H4513_049_4	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:22:10 PM Central Daylight Time	08/02/2022 12:52:20 PM Central Daylight Time	08/01/2022 10:51:42 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	049	4	2023	Tennessee	Memphis	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	5	1	01	01	H4513_049_5	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:22:38 PM Central Daylight Time	08/02/2022 12:53:13 PM Central Daylight Time	08/01/2022 10:52:13 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	049	5	2023	Tennessee	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	050	0	1	01	01	H4513_050_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:23:10 PM Central Daylight Time	08/02/2022 12:55:25 PM Central Daylight Time	08/01/2022 10:52:44 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	050	0	2023	Central Arkansas		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(877)363-5114		(877)363-5114		(800)668-3813		(800)668-3813		(877)363-5114		(877)363-5114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	051	0	1	01	01	H4513_051_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:24:11 PM Central Daylight Time	08/02/2022 12:56:01 PM Central Daylight Time	08/01/2022 10:53:15 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	051	0	2023	West Arkansas		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(877)363-5114		(877)363-5114		(800)668-3813		(800)668-3813		(877)363-5114		(877)363-5114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	052	0	1	01	01	H4513_052_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:24:52 PM Central Daylight Time	08/02/2022 12:56:49 PM Central Daylight Time	08/01/2022 10:53:47 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	052	0	2023	Northwest Arkansas		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(877)363-5114		(877)363-5114		(800)668-3813		(800)668-3813		(877)363-5114		(877)363-5114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	053	0	1	01	01	H4513_053_0	4	1						05/12/2022	2023.01	05/12/2022 01:11:10 PM Central Daylight Time	08/02/2022 12:57:53 PM Central Daylight Time	08/01/2022 10:54:19 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H4513	053	0	2023	West Tennessee/Memphis		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		1	08/02/2022	2023.01	08/02/2022 04:26:25 PM Central Daylight Time	08/02/2022 07:26:46 PM Central Daylight Time	08/01/2022 10:54:50 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	054	0	2023	Huntsville		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(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	1		0	05/22/2022	2023.01	05/22/2022 03:32:49 PM Central Daylight Time	08/02/2022 07:30:18 PM Central Daylight Time	08/01/2022 10:55:23 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	055	0	2023	Huntsville		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(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	1		0	06/01/2022	2023.01	06/01/2022 10:09:49 PM Central Daylight Time	08/02/2022 07:34:38 PM Central Daylight Time	08/01/2022 10:55:55 AM Central Daylight Time			08/04/2022 02:09:36 PM 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	2023	Alabama	Birmingham/Mobile/Montgomery	2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	056	2	1	01	01	H4513_056_2	5	1	2	1	1		0	07/01/2022	2023.01	07/01/2022 11:00:59 AM Central Daylight Time	08/02/2022 07:36:47 PM Central Daylight Time	08/01/2022 10:56:27 AM Central Daylight Time			08/04/2022 02:09:36 PM 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	2023	Alabama	Huntsville	2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	057	0	1	01	01	H4513_057_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:26:56 PM Central Daylight Time	08/02/2022 07:38:34 PM Central Daylight Time	08/01/2022 10:56:58 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	057	0	2023	Birmingham/Mobile/Montgomery		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	059	0	1	01	01	H4513_059_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:30:15 PM Central Daylight Time	08/02/2022 01:17:48 PM Central Daylight Time	08/01/2022 10:57:29 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	059	0	2023	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	1		0	06/01/2022	2023.01	06/01/2022 10:08:49 PM Central Daylight Time	08/03/2022 08:54:13 AM Central Daylight Time	08/01/2022 10:58:02 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	060	1	2023	Texas	Houston	2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(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	1		0	06/01/2022	2023.01	06/01/2022 10:08:39 PM Central Daylight Time	08/03/2022 08:54:39 AM Central Daylight Time	08/01/2022 10:58:34 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	060	2	2023	Texas	Valley	2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(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	1		0	06/01/2022	2023.01	06/01/2022 10:08:27 PM Central Daylight Time	08/03/2022 08:55:13 AM Central Daylight Time	08/01/2022 10:59:07 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	060	3	2023	Texas	El Paso	2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	060	4	1	01	01	H4513_060_4	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 10:08:16 PM Central Daylight Time	08/03/2022 08:56:07 AM Central Daylight Time	08/01/2022 10:59:39 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	060	4	2023	Texas	San Antonio	2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	060	5	1	01	01	H4513_060_5	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 10:08:05 PM Central Daylight Time	08/03/2022 08:56:51 AM Central Daylight Time	08/01/2022 11:00:11 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	060	5	2023	Texas	Dallas/Fort Worth	2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	061	1	1	01	01	H4513_061_1	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:52:26 PM Central Daylight Time	08/03/2022 08:57:25 AM Central Daylight Time	08/01/2022 11:00:42 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	061	1	2023	Texas	Houston	2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	061	2	1	01	01	H4513_061_2	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:53:04 PM Central Daylight Time	08/03/2022 08:58:17 AM Central Daylight Time	08/01/2022 11:01:14 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	061	2	2023	Texas	Valley	2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	061	3	1	01	01	H4513_061_3	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:53:35 PM Central Daylight Time	08/03/2022 08:59:04 AM Central Daylight Time	08/01/2022 11:01:45 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	061	3	2023	Texas	El Paso	2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	061	4	1	01	01	H4513_061_4	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:54:40 PM Central Daylight Time	08/03/2022 08:59:46 AM Central Daylight Time	08/01/2022 11:02:17 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	061	4	2023	Texas	San Antonio	2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	061	5	1	01	01	H4513_061_5	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:55:15 PM Central Daylight Time	08/03/2022 09:00:20 AM Central Daylight Time	08/01/2022 11:02:48 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	061	5	2023	Texas	Dallas	2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	062	0	1	01	01	H4513_062_0	3	1				0	0	07/18/2022	2023.01	07/18/2022 02:36:14 PM Central Daylight Time	06/01/2022 03:12:26 PM Central Daylight Time				07/18/2022 04:55:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H4513	062	0	2023	El Paso/San Antonio		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	063	0	1	01	01	H4513_063_0	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:49:17 PM Central Daylight Time	08/03/2022 04:18:56 PM Central Daylight Time	08/01/2022 11:03:21 AM Central Daylight Time			08/04/2022 04:14:31 PM 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	2023	Alabama		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	064	0	1	01	01	H4513_064_0	5	1			2		1	08/02/2022	2023.01	08/02/2022 08:55:41 PM Central Daylight Time	08/03/2022 09:01:51 AM Central Daylight Time	08/01/2022 11:03:52 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Alliance Medicare (HMO)	01	01		1			H4513	064	0	2023	Houston		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	066	0	1	01	01	H4513_066_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:56:07 PM Central Daylight Time	08/03/2022 09:02:30 AM Central Daylight Time	08/01/2022 11:04:23 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H4513	066	0	2023	Texas		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	068	1	1	01	01	H4513_068_1	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:31:13 PM Central Daylight Time	08/02/2022 12:58:55 PM Central Daylight Time	08/01/2022 11:04:55 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H4513	068	1	2023	Tennessee	Nashville/Chattanooga	2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	068	2	1	01	01	H4513_068_2	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:31:49 PM Central Daylight Time	08/02/2022 12:59:58 PM Central Daylight Time	08/01/2022 11:05:27 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H4513	068	2	2023	Tennessee	Memphis	2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	070	0	1	01	01	H4513_070_0	4	1						05/15/2022	2023.01	05/15/2022 12:23:29 PM Central Daylight Time	08/02/2022 01:01:21 PM Central Daylight Time	08/01/2022 11:06:00 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H4513	070	0	2023	Nashville		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	073	0	1	01	01	H4513_073_0	5	1			2		1	08/02/2022	2023.01	08/02/2022 08:56:46 PM Central Daylight Time	08/03/2022 09:03:05 AM Central Daylight Time	08/01/2022 11:06:31 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H4513	073	0	2023	Oklahoma City		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	074	0	1	01	01	H4513_074_0	5	1			2		1	08/02/2022	2023.01	08/02/2022 10:16:08 PM Central Daylight Time	08/03/2022 09:03:38 AM Central Daylight Time	08/01/2022 11:07:04 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	074	0	2023	Corpus Christi		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	075	0	1	01	01	H4513_075_0	4	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 07:24:04 PM Central Daylight Time	08/03/2022 09:04:25 AM Central Daylight Time	08/01/2022 11:07:37 AM Central Daylight Time			08/04/2022 02:09:36 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	075	0	2023	Corpus Christi		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	804	0	1	01	01	H4513_804_0	2	1						05/22/2022	2023.01	05/22/2022 05:33:59 PM Central Daylight Time					06/02/2022 08:40:51 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignahealthspring.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	804	0	2023	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	3	1						06/15/2022	2023.01	06/15/2022 04:08:19 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	815	0	2023	Statewide IL, MS and TN		1	9072	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	817	0	1	01	01	H4513_817_0	2	1						05/22/2022	2023.01	05/22/2022 05:37:31 PM Central Daylight Time					06/02/2022 08:40:51 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	817	0	2023	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	3	1						06/15/2022	2023.01	06/15/2022 04:08:37 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	819	0	2023	Statewide AR		1	36	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						05/22/2022	2023.01	05/22/2022 05:34:52 PM Central Daylight Time					06/02/2022 08:40:51 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	821	0	2023	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	02	01	H4514_007_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 05:39:01 PM Central Daylight Time	08/03/2022 11:52:09 AM Central Daylight Time	07/31/2022 02:30:31 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H4514	007	0	2023	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	02	01	H4514_013_1	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:39:10 PM Central Daylight Time	08/03/2022 11:52:47 AM Central Daylight Time	07/31/2022 02:30:56 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H4514	013	1	2023	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	02	01	H4514_013_2	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:39:18 PM Central Daylight Time	08/03/2022 11:53:25 AM Central Daylight Time	07/31/2022 02:31:21 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H4514	013	2	2023	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	02	01	H4514_013_3	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:39:27 PM Central Daylight Time	08/03/2022 11:54:03 AM Central Daylight Time	07/31/2022 02:31:46 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H4514	013	3	2023	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	08/03/2022	2023.01	08/03/2022 05:39:40 PM Central Daylight Time	08/03/2022 11:54:40 AM Central Daylight Time	07/31/2022 02:32:10 AM Central Daylight Time			08/05/2022 10:24:03 AM 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	2023	Fort Bend and Harris 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			
H4514	015	0	1	02	01	H4514_015_0	3	1		1	2		1	08/03/2022	2023.01	08/03/2022 05:39:51 PM Central Daylight Time	08/03/2022 11:55:17 AM Central Daylight Time	07/31/2022 02:32:35 AM Central Daylight Time			08/05/2022 10:24:03 AM 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	2023	Fort Bend and Harris counties		2		2			1	4			00000000000000000010000					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			
H4514	016	0	1	02	01	H4514_016_0	5	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:40:01 PM Central Daylight Time	08/03/2022 11:55:54 AM Central Daylight Time	07/31/2022 02:33:00 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Ally (HMO-POS D-SNP)	01	02		1			H4514	016	0	2023	Fort Bend and Harris 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			
H4514	017	0	1	02	01	H4514_017_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 05:40:13 PM Central Daylight Time	08/03/2022 11:56:31 AM Central Daylight Time	07/31/2022 02:33:24 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4514	017	0	2023	East Tx		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(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	018	0	1	02	01	H4514_018_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:40:24 PM Central Daylight Time	08/03/2022 11:57:08 AM Central Daylight Time	07/31/2022 02:33:49 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H4514	018	0	2023	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	019	0	1	02	01	H4514_019_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:40:34 PM Central Daylight Time	08/03/2022 11:57:45 AM Central Daylight Time	07/31/2022 02:34:14 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H4514	019	0	2023	East Tx		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						06/03/2022	2023.01	06/03/2022 10:38:19 AM Eastern Daylight Time					06/03/2022 03:31:31 PM 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	2023	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	06/03/2022	2023.01	06/03/2022 10:38:31 AM Eastern Daylight Time					06/03/2022 03:31:31 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 10:38:41 AM Eastern Daylight Time					06/03/2022 03:31:31 PM 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	2023	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						06/01/2022	2023.01	06/01/2022 12:08:40 PM Central Daylight Time		05/31/2022 03:49:24 PM Central Daylight Time			06/01/2022 12:10:56 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	2023	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						06/01/2022	2023.01	06/01/2022 12:09:20 PM Central Daylight Time		05/31/2022 03:48:04 PM Central Daylight Time			06/01/2022 12:10:56 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	2023	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						06/01/2022	2023.01	06/01/2022 11:19:08 AM Mountain Daylight Time		06/01/2022 10:48:01 AM Mountain Daylight Time			06/01/2022 11:21:49 AM 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	2023	El Paso, Texas and El Paso County		2		2			2									www.bienvivir.org	www.bienvivir.org										(915)562-3444	1315	(915)562-3444	1315	(915)562-3444	1801	(915)562-3444	1801									(915)562-3444	1315	(915)562-3444	1315	(915)562-3444	1801	(915)562-3444	1801															
H4518	002	0	1	20	08	H4518_002_0	1	1						06/01/2022	2023.01	06/01/2022 11:19:01 AM Mountain Daylight Time		06/01/2022 10:48:01 AM Mountain Daylight Time			06/01/2022 11:21:49 AM 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	2023	El Paso, Texas and El Paso County		2		2			2									www.bienvivir.org	www.bienvivir.org										(915)562-3444	1315	(915)562-3444	1315	(915)562-3444	1801	(915)562-3444	1801									(915)562-3444	1315	(915)562-3444	1315	(915)562-3444	1801	(915)562-3444	1801															
H4523	001	0	1	01	01	H4523_001_0	3	1						08/01/2022	2023.01	08/01/2022 06:14:44 PM Central Daylight Time	08/02/2022 01:58:02 PM Central Daylight Time	07/31/2022 09:57:36 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	001	0	2023	San Antonio and Austin 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	2			
H4523	015	0	1	01	01	H4523_015_0	2	1						08/01/2022	2023.01	08/01/2022 06:15:35 PM Central Daylight Time	08/02/2022 01:59:06 PM Central Daylight Time	07/31/2022 09:58:02 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	015	0	2023	Houston and Surrounding Areas		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			
H4523	020	0	1	01	01	H4523_020_0	2	1						08/01/2022	2023.01	08/01/2022 06:16:26 PM Central Daylight Time	08/02/2022 02:00:14 PM Central Daylight Time	07/31/2022 09:58:28 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	020	0	2023	Bexar and Comal 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	2			
H4523	021	0	1	01	01	H4523_021_0	2	1						08/01/2022	2023.01	08/01/2022 06:17:42 PM Central Daylight Time	08/02/2022 02:01:36 PM Central Daylight Time	07/31/2022 09:58:54 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	021	0	2023	Dallas 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	2			
H4523	024	0	1	01	01	H4523_024_0	2	1						08/01/2022	2023.01	08/01/2022 06:18:37 PM Central Daylight Time	08/02/2022 02:02:38 PM Central Daylight Time	07/31/2022 09:59:22 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	024	0	2023	Harris 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	2			
H4523	801	0	1	01	01	H4523_801_0	1	1				0	0	05/27/2022	2023.01	05/27/2022 04:07:01 PM Eastern Daylight Time					06/02/2022 03:21:49 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H4523	801	0	2023	Texas		1	650	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H4523	802	0	1	01	01	H4523_802_0	1	1						05/30/2022	2023.01	05/30/2022 11:17:40 AM Eastern Daylight Time					06/02/2022 03:21:49 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	2023	Texas		1	4050	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H4527	001	0	1	02	01	H4527_001_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 05:40:47 PM Central Daylight Time	08/03/2022 11:32:06 AM Central Daylight Time	07/31/2022 02:34:39 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4527	001	0	2023	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	02	01	H4527_002_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 05:40:58 PM Central Daylight Time	08/03/2022 11:32:37 AM Central Daylight Time	07/31/2022 02:35:04 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4527	002	0	2023	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	02	01	H4527_003_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:41:07 PM Central Daylight Time	08/03/2022 11:33:09 AM Central Daylight Time	07/31/2022 02:35:28 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H4527	003	0	2023	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	02	01	H4527_004_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:41:16 PM Central Daylight Time	08/03/2022 11:33:42 AM Central Daylight Time	07/31/2022 02:35:53 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H4527	004	0	2023	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	02	01	H4527_005_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 05:41:28 PM Central Daylight Time	08/03/2022 11:34:15 AM Central Daylight Time	07/31/2022 02:36:18 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4527	005	0	2023	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	02	01	H4527_006_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:41:38 PM Central Daylight Time	08/03/2022 11:34:47 AM Central Daylight Time	07/31/2022 02:36:43 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H4527	006	0	2023	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	02	01	H4527_013_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 05:41:48 PM Central Daylight Time	08/03/2022 11:35:21 AM Central Daylight Time	07/31/2022 02:37:07 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4527	013	0	2023	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	02	01	H4527_015_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:41:58 PM Central Daylight Time	08/03/2022 11:35:56 AM Central Daylight Time	07/31/2022 02:37:32 AM Central Daylight Time			08/05/2022 10:24:03 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H4527	015	0	2023	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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 10:55:31 AM Central Daylight Time	06/01/2022 11:51:31 AM Central Daylight Time				06/02/2022 11:40:10 AM 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	2023	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	08/03/2022	2023.01	08/03/2022 05:42:17 PM Central Daylight Time	08/03/2022 11:36:28 AM Central Daylight Time	07/31/2022 02:37:57 AM Central Daylight Time			08/05/2022 10:51:58 AM 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	2023	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	02	01	H4527_039_0	3	1		1	2		1	08/03/2022	2023.01	08/03/2022 05:42:30 PM Central Daylight Time	08/03/2022 11:37:00 AM Central Daylight Time	07/31/2022 02:38:21 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H4527	039	0	2023	Bastrop, Hays, Travis, and Williamson counties		2		2			1	4			00000000000000000010000					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	02	01	H4527_040_0	3	1		1	2		1	08/03/2022	2023.01	08/03/2022 05:42:42 PM Central Daylight Time	08/03/2022 11:37:32 AM Central Daylight Time	07/31/2022 02:38:46 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H4527	040	0	2023	El Paso County		2		2			1	4			00000000000000000010000					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	02	01	H4527_041_0	4	1		1	2		1	08/03/2022	2023.01	08/03/2022 05:42:52 PM Central Daylight Time	08/03/2022 11:38:06 AM Central Daylight Time	07/31/2022 02:39:10 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H4527	041	0	2023	Corpus Christi Metro Area		2		2			1	4			00000000000000000010000					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	02	01	H4527_042_0	3	1		1	2		1	08/03/2022	2023.01	08/03/2022 05:43:03 PM Central Daylight Time	08/03/2022 11:38:38 AM Central Daylight Time	07/31/2022 02:39:34 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H4527	042	0	2023	Cameron, Hidalgo, Starr, and Willacy Counties		2		2			1	4			00000000000000000010000					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	045	0	1	02	01	H4527_045_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 05:43:14 PM Central Daylight Time	08/03/2022 11:39:11 AM Central Daylight Time	07/31/2022 02:39:59 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4527	045	0	2023	Archer, Clay, and Wichita 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			
H4527	801	0	1	01	01	H4527_801_0	1	1						06/03/2022	2023.01	06/03/2022 10:42:24 AM Eastern Daylight Time					06/03/2022 03:33:20 PM Eastern Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4527	801	0	2023	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	06/03/2022	2023.01	06/03/2022 10:42:35 AM Eastern Daylight Time					06/03/2022 03:33:20 PM Eastern Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4527	802	0	2023	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						06/03/2022	2023.01	06/03/2022 10:42:46 AM Eastern Daylight Time					06/03/2022 03:33:20 PM Eastern Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4527	803	0	2023	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						08/01/2022	2023.01	08/01/2022 01:07:09 PM Eastern Daylight Time	08/03/2022 09:20:17 PM Eastern Daylight Time	07/30/2022 09:15:32 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC	Wellcare	www.wellcareOK.com	Wellcare No Premium Open (PPO)	01	04		1			H4537	001	0	2023	Select counties in OK		2		2			2									www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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						08/01/2022	2023.01	08/01/2022 01:09:05 PM Eastern Daylight Time	08/03/2022 09:21:30 PM Eastern Daylight Time	07/30/2022 09:16:04 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC	Wellcare	www.wellcareOK.com	Wellcare No Premium Open (PPO)	01	04		1			H4537	002	0	2023	Select counties in OK		2		2			2									www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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	003	0	1	04	01	H4537_003_0	5	1						08/01/2022	2023.01	08/01/2022 01:12:57 PM Eastern Daylight Time	08/03/2022 09:22:43 PM Eastern Daylight Time	07/30/2022 09:16:35 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC	Wellcare	www.wellcareOK.com	Wellcare Low Premium Open (PPO)	01	04		1			H4537	003	0	2023	Select Counties in OK		2		2			2									www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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	004	0	1	04	01	H4537_004_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:12:47 PM Eastern Daylight Time	08/03/2022 09:23:55 PM Eastern Daylight Time	07/30/2022 09:17:07 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC	Wellcare	www.wellcareOK.com	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H4537	004	0	2023	Select Counties in OK		2		2			1	3		1					1	www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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	08/03/2022	2023.01	08/03/2022 12:00:43 PM Central Daylight Time	08/03/2022 11:06:03 AM Central Daylight Time	07/31/2022 02:40:23 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices (PPO)	01	04		1			H4544	001	0	2023	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	2	1				0	0	07/11/2022	2023.01	07/11/2022 05:14:46 PM Central Daylight Time	06/01/2022 10:44:24 AM Central Daylight Time				07/18/2022 10:43:18 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Patriot (PPO)	01	04		1			H4544	002	0	2023	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	02	01	H4590_010_0	7	1			2		1	08/03/2022	2023.01	08/03/2022 05:43:28 PM Central Daylight Time	08/03/2022 11:50:59 AM Central Daylight Time	08/01/2022 01:11:00 PM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H4590	010	0	2023	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	5	1			2		1	08/03/2022	2023.01	08/03/2022 05:43:40 PM Central Daylight Time	08/03/2022 11:51:36 AM Central Daylight Time	08/01/2022 01:12:48 PM Central Daylight Time			08/05/2022 10:51:58 AM 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	2023	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	02	01	H4590_020_0	5	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:43:49 PM Central Daylight Time	08/03/2022 11:52:15 AM Central Daylight Time	08/01/2022 01:14:36 PM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H4590	020	0	2023	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	02	01	H4590_022_0	5	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:43:58 PM Central Daylight Time	08/03/2022 11:52:53 AM Central Daylight Time	08/01/2022 01:16:23 PM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H4590	022	0	2023	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	02	01	H4590_025_0	5	1			2		1	08/03/2022	2023.01	08/03/2022 05:44:12 PM Central Daylight Time	08/03/2022 11:53:30 AM Central Daylight Time	08/01/2022 01:18:13 PM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO-POS)	01	02		1			H4590	025	0	2023	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	3	1			2	0	0	05/31/2022	2023.01	05/31/2022 11:08:03 AM Central Daylight Time	06/03/2022 11:57:05 AM Central Daylight Time				06/03/2022 06:03:40 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	2023	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	02	01	H4590_029_0	3	1			2	0	0	05/31/2022	2023.01	05/31/2022 11:08:46 AM Central Daylight Time	06/03/2022 11:57:49 AM Central Daylight Time				06/03/2022 06:03:40 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H4590	029	0	2023	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	02	01	H4590_033_0	5	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:44:34 PM Central Daylight Time	08/03/2022 11:54:08 AM Central Daylight Time	08/01/2022 01:20:01 PM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H4590	033	0	2023	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	02	01	H4590_037_0	5	1		1	2		1	08/03/2022	2023.01	08/03/2022 05:44:45 PM Central Daylight Time	08/03/2022 11:54:46 AM Central Daylight Time	08/01/2022 01:21:51 PM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO-POS C-SNP)	01	02		1			H4590	037	0	2023	San Antonio Metro Area		2		2			1	4			00011010000000000000000					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	5	1			2		1	08/03/2022	2023.01	08/03/2022 05:44:57 PM Central Daylight Time	08/03/2022 11:55:24 AM Central Daylight Time	08/01/2022 01:23:41 PM Central Daylight Time			08/05/2022 10:51:58 AM 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	2023	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	5	1			2		1	08/03/2022	2023.01	08/03/2022 05:45:08 PM Central Daylight Time	08/03/2022 11:56:03 AM Central Daylight Time	08/01/2022 01:25:32 PM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4590	042	0	2023	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	5	1			2		1	08/03/2022	2023.01	08/03/2022 05:45:19 PM Central Daylight Time	08/03/2022 11:56:41 AM Central Daylight Time	08/01/2022 01:27:22 PM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4590	043	0	2023	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	5	1		1	2		1	08/03/2022	2023.01	08/03/2022 05:45:30 PM Central Daylight Time	08/03/2022 11:57:19 AM Central Daylight Time	08/01/2022 01:29:13 PM Central Daylight Time			08/05/2022 10:51:58 AM 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	2023	Dallas Metro Area		2		2			1	4			00011010000000000000000					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	02	01	H4590_045_0	5	1			2		1	08/03/2022	2023.01	08/03/2022 05:45:41 PM Central Daylight Time	08/03/2022 11:57:58 AM Central Daylight Time	08/01/2022 01:31:02 PM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4590	045	0	2023	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	06/03/2022	2023.01	06/03/2022 10:43:19 AM Eastern Daylight Time					06/03/2022 03:34:37 PM Eastern Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	801	0	2023	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						06/03/2022	2023.01	06/03/2022 10:43:30 AM Eastern Daylight Time					06/03/2022 03:34:37 PM Eastern Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	803	0	2023	TX Employer Sponsored Plan Service Area		1	12900	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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						06/03/2022	2023.01	06/03/2022 10:43:41 AM Eastern Daylight Time					06/03/2022 03:34:37 PM Eastern Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	804	0	2023	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	02	01	H4604_003_0	2	1					1	06/02/2022	2023.01	06/02/2022 09:04:11 AM Central Daylight Time	08/03/2022 11:22:16 AM Central Daylight Time	07/31/2022 02:45:47 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H4604	003	0	2023	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	02	01	H4604_005_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 11:15:14 AM Central Daylight Time	06/01/2022 10:13:52 AM Central Daylight Time				06/03/2022 11:13:47 AM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H4604	005	0	2023	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	02	01	H4604_011_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:16:07 AM Central Daylight Time	08/03/2022 11:22:52 AM Central Daylight Time	07/31/2022 02:46:11 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H4604	011	0	2023	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	02	01	H4604_012_0	2	1					1	08/02/2022	2023.01	08/02/2022 01:54:58 PM Central Daylight Time	08/03/2022 11:23:29 AM Central Daylight Time	07/31/2022 02:46:36 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4604	012	0	2023	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	02	01	H4604_013_0	2	1					1	05/31/2022	2023.01	05/31/2022 11:24:54 AM Central Daylight Time	08/03/2022 11:24:07 AM Central Daylight Time	07/31/2022 02:47:01 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H4604	013	0	2023	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	02	01	H4604_014_0	2	1					1	05/31/2022	2023.01	05/31/2022 11:27:57 AM Central Daylight Time	08/03/2022 11:24:45 AM Central Daylight Time	07/31/2022 02:47:25 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H4604	014	0	2023	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	02	01	H4604_015_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:22:44 AM Central Daylight Time	08/03/2022 11:25:23 AM Central Daylight Time	07/31/2022 02:47:49 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H4604	015	0	2023	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	02	01	H4604_016_0	2	1					1	08/02/2022	2023.01	08/02/2022 01:57:04 PM Central Daylight Time	08/03/2022 11:25:59 AM Central Daylight Time	07/31/2022 02:48:14 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H4604	016	0	2023	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	02	01	H4604_017_0	2	1		1			1	08/02/2022	2023.01	08/02/2022 11:28:22 AM Central Daylight Time	08/03/2022 11:26:37 AM Central Daylight Time	07/31/2022 02:48:38 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (HMO-POS C-SNP)	01	02		1			H4604	017	0	2023	Select Counties in Utah		2		2			1	4			00000000000000000010000					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	02	01	H4604_018_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:34:16 AM Central Daylight Time	08/03/2022 11:27:13 AM Central Daylight Time	07/31/2022 02:49:03 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO-POS)	01	02		1			H4604	018	0	2023	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	02	01	H4604_019_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 12:45:33 PM Central Daylight Time	06/01/2022 10:19:59 AM Central Daylight Time				06/03/2022 11:13:47 AM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H4604	019	0	2023	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	02	01	H4604_020_0	2	1					1	08/02/2022	2023.01	08/02/2022 02:01:02 PM Central Daylight Time	08/03/2022 11:27:48 AM Central Daylight Time	07/31/2022 02:49:27 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H4604	020	0	2023	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	02	01	H4604_022_0	2	1					1	08/02/2022	2023.01	08/02/2022 02:04:38 PM Central Daylight Time	08/03/2022 11:28:25 AM Central Daylight Time	07/31/2022 02:49:52 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H4604	022	0	2023	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	801	0	1	01	01	H4604_801_0	1	1						06/03/2022	2023.01	06/03/2022 09:56:19 AM Central Daylight Time					06/03/2022 02:50:26 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	801	0	2023	Salt Lake and Surrounding 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					1				
H4604	803	0	1	01	01	H4604_803_0	1	1						06/03/2022	2023.01	06/03/2022 09:56:32 AM Central Daylight Time					06/03/2022 02:50:26 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	803	0	2023	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	06/03/2022	2023.01	06/03/2022 09:56:46 AM Central Daylight Time					06/03/2022 02:50:26 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	805	0	2023	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				
H4604	809	0	1	01	01	H4604_809_0	1	1						06/03/2022	2023.01	06/03/2022 09:56:59 AM Central Daylight Time					06/03/2022 02:50:26 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	809	0	2023	ID		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	810	0	1	01	01	H4604_810_0	1	1						06/03/2022	2023.01	06/03/2022 09:57:15 AM Central Daylight Time					06/03/2022 02:50:26 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	810	0	2023	ID		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	811	0	1	01	01	H4604_811_0	1	1				0	0	06/03/2022	2023.01	06/03/2022 09:57:27 AM Central Daylight Time					06/03/2022 02:50:26 PM Central Daylight Time	UNITEDHEALTHCARE OF THE ROCKIES, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	811	0	2023	ID		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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;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	6	1			2	0	0	07/06/2022	2023.01	07/06/2022 01:56:44 PM Pacific Daylight Time	06/01/2022 05:22:50 PM Pacific Daylight Time				07/11/2022 09:05:44 AM 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	2023	Select Counties in Utah		2		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)-		(800)735-2900		(711)-										2					2						2			
H4605	002	0	1	04	01	H4605_002_0	8	1			1		1	08/04/2022	2023.01	08/04/2022 04:12:47 PM Pacific Daylight Time	08/04/2022 02:33:56 PM Pacific Daylight Time	08/01/2022 01:50:38 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Utah		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H4605	004	0	1	04	01	H4605_004_0	9	1			1		1	07/06/2022	2023.01	07/06/2022 01:57:39 PM Pacific Daylight Time	08/04/2022 02:34:35 PM Pacific Daylight Time	08/01/2022 01:51:48 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Davis, Salt Lake, Utah, and Weber counties		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H4605	007	0	1	04	01	H4605_007_0	9	1			1		1	08/04/2022	2023.01	08/04/2022 11:42:37 AM Pacific Daylight Time	08/04/2022 02:35:15 PM Pacific Daylight Time	08/01/2022 01:52:58 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Utah		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H4605	008	0	1	04	01	H4605_008_0	9	1			1		1	08/04/2022	2023.01	08/04/2022 11:59:32 AM Pacific Daylight Time	08/04/2022 02:35:54 PM Pacific Daylight Time	08/01/2022 01:54:05 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Iron and Washington Counties		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H4605	009	0	1	04	01	H4605_009_0	8	1			1		1	08/04/2022	2023.01	08/04/2022 03:35:11 PM Pacific Daylight Time	08/04/2022 02:36:33 PM Pacific Daylight Time	08/01/2022 01:55:11 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Iron and Washington Counties		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H4605	801	0	1	04	01	H4605_801_0	1	1				0	0	04/20/2022	2023.01	04/20/2022 01:51:34 PM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	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	1	1						05/06/2022	2023.01	05/06/2022 09:40:07 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	Nationwide except territories		1	6670	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	1	1						04/19/2022	2023.01	04/19/2022 09:07:28 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	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	1	1						04/19/2022	2023.01	04/19/2022 09:07:48 AM Pacific Daylight Time					05/17/2022 02:26:52 PM 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	2023	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									
H4620	001	0	1	04	01	H4620_001_0	6	1					1	08/02/2022	2023.01	08/02/2022 02:24:54 PM Central Daylight Time	08/05/2022 05:22:59 AM Central Daylight Time	08/05/2022 05:22:30 AM Central Daylight Time			08/05/2022 05:42:12 AM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Choice (PPO)	01	04		1			H4620	001	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4620	801	0	1	04	01	H4620_801_0	2	1						06/02/2022	2023.01	06/02/2022 10:42:30 AM Central Daylight Time					06/03/2022 12:31:12 PM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD Calendar Year (PPO)	01	04		1			H4620	801	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H4620	802	0	1	04	01	H4620_802_0	2	1						06/02/2022	2023.01	06/02/2022 10:43:06 AM Central Daylight Time					06/03/2022 12:31:12 PM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD non-Calendar Year (PPO)	01	04		1			H4620	802	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H4620	803	0	1	04	01	H4620_803_0	2	1				0	0	06/02/2022	2023.01	06/02/2022 10:43:37 AM Central Daylight Time					06/03/2022 12:31:12 PM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only Calendar Year (PPO)	01	04		1			H4620	803	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H4620	804	0	1	04	01	H4620_804_0	2	1				0	0	06/02/2022	2023.01	06/02/2022 10:44:11 AM Central Daylight Time					06/03/2022 12:31:12 PM Central Daylight Time	ESSENCE HEALTHCARE OF OHIO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only non-Calendar Year (PPO)	01	04		1			H4620	804	0	2023	OH- Butler, Clermont, Hamilton and Warren counties		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(877)218-6018		(877)218-6018										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H4623	001	0	1	02	01	H4623_001_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:36:22 PM Eastern Daylight Time	08/03/2022 03:44:17 PM Eastern Daylight Time	07/30/2022 06:47:42 AM Eastern Daylight Time			08/04/2022 10:43:49 AM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4623-001 (HMO-POS)	01	02		1			H4623	001	0	2023	Southwest Missouri		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H4623_002_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:36:32 PM Eastern Daylight Time	08/03/2022 03:50:29 PM Eastern Daylight Time	07/30/2022 06:48:06 AM Eastern Daylight Time			08/04/2022 10:43:49 AM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Community (HMO-POS)	01	02		1			H4623	002	0	2023	Select Counties in Southwest Missouri		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	10	1					1	08/05/2022	2023.01	08/05/2022 08:53:44 AM Central Daylight Time	08/05/2022 09:14:32 AM Central Daylight Time	08/05/2022 09:15:22 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Choice IL (HMO)	01	01		1			H4624	001	0	2023	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	9	1					1	08/05/2022	2023.01	08/05/2022 08:54:35 AM Central Daylight Time	08/05/2022 09:14:32 AM Central Daylight Time	08/05/2022 09:15:22 AM Central Daylight Time			08/05/2022 10:08:19 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	2023	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	9	1					1	08/05/2022	2023.01	08/05/2022 08:55:34 AM Central Daylight Time	08/05/2022 09:14:32 AM Central Daylight Time	08/05/2022 09:15:22 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Choice IN (HMO)	01	01		1			H4624	003	0	2023	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	9	1					1	08/05/2022	2023.01	08/05/2022 08:56:08 AM Central Daylight Time	08/05/2022 09:14:32 AM Central Daylight Time	08/05/2022 09:15:23 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Choice MI (HMO)	01	01		1			H4624	006	0	2023	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	9	1					1	08/05/2022	2023.01	08/05/2022 08:56:57 AM Central Daylight Time	08/05/2022 09:14:33 AM Central Daylight Time	08/05/2022 09:15:23 AM Central Daylight Time			08/05/2022 10:08:19 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	2023	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	9	1		1			1	08/05/2022	2023.01	08/05/2022 08:57:24 AM Central Daylight Time	08/05/2022 09:14:33 AM Central Daylight Time	08/05/2022 09:15:23 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Essential Wellness Diabetes and Heart IL (HMO C-SNP)	01	01		1			H4624	010	0	2023	Cook, Kane & Will Counties & Rockford Area		2		2			1	4			00000000000000000010000					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	9	1		1			1	08/05/2022	2023.01	08/05/2022 08:58:06 AM Central Daylight Time	08/05/2022 09:14:33 AM Central Daylight Time	08/05/2022 09:15:23 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Essential Wellness Diabetes and Heart IN (HMO C-SNP)	01	01		1			H4624	011	0	2023	Allen, Lake & Marion Counties		2		2			1	4			00000000000000000010000					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	9	1		1			1	08/05/2022	2023.01	08/05/2022 08:58:36 AM Central Daylight Time	08/05/2022 09:14:33 AM Central Daylight Time	08/05/2022 09:15:23 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Essential Wellness Diabetes and Heart MI (HMO C-SNP)	01	01		1			H4624	012	0	2023	Genesee, Oakland & Wayne Counties		2		2			1	4			00000000000000000010000					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	10	1					1	08/05/2022	2023.01	08/05/2022 08:59:08 AM Central Daylight Time	08/05/2022 09:14:33 AM Central Daylight Time	08/05/2022 09:15:24 AM Central Daylight Time			08/05/2022 10:08:19 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	2023	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	8	1	2	1			0	08/05/2022	2023.01	08/05/2022 08:59:43 AM Central Daylight Time	08/05/2022 09:14:33 AM Central Daylight Time	08/05/2022 09:15:24 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Dual Complete Plus IN (HMO-POS D-SNP)	01	02		1			H4624	016	0	2023	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	9	1					1	08/05/2022	2023.01	08/05/2022 09:00:05 AM Central Daylight Time	08/05/2022 09:14:33 AM Central Daylight Time	08/05/2022 09:15:24 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Signature Care IN (HMO-POS)	01	02		1			H4624	017	0	2023	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	8	1	2	1			0	08/05/2022	2023.01	08/05/2022 09:00:40 AM Central Daylight Time	08/05/2022 09:14:34 AM Central Daylight Time	08/05/2022 09:15:24 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Dual Platinum Plus IN (HMO-POS D-SNP)	01	02		1			H4624	018	0	2023	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	08/05/2022	2023.01	08/05/2022 09:01:53 AM Central Daylight Time	08/05/2022 09:14:34 AM Central Daylight Time	08/05/2022 09:15:24 AM Central Daylight Time			08/05/2022 10:08:19 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Dual Complete Plus MI (HMO D-SNP)	01	01		1			H4624	019	0	2023	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	020	0	1	01	01	H4624_020_0	11	1					1	08/10/2022	2023.01	08/10/2022 09:56:19 AM Central Daylight Time	08/05/2022 09:14:34 AM Central Daylight Time	08/05/2022 09:15:24 AM Central Daylight Time			08/10/2022 11:30:17 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Premium Giveback IN (HMO)	01	01		1			H4624	020	0	2023	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	021	0	1	01	01	H4624_021_0	11	1					1	08/10/2022	2023.01	08/10/2022 09:56:57 AM Central Daylight Time	08/05/2022 09:14:34 AM Central Daylight Time	08/05/2022 09:15:24 AM Central Daylight Time			08/10/2022 11:30:17 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Premium Giveback MI (HMO)	01	01		1			H4624	021	0	2023	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	801	0	1	01	01	H4624_801_0	4	1						06/02/2022	2023.01	06/02/2022 10:59:53 AM Central Daylight Time					06/05/2022 05:22:56 PM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing EGWP CY (HMO)	01	01		1			H4624	801	0	2023	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	4	1						06/02/2022	2023.01	06/02/2022 11:00:04 AM Central Daylight Time					06/05/2022 05:22:56 PM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing EGWP NCY (HMO)	01	01		1			H4624	802	0	2023	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	4	1				0	0	06/02/2022	2023.01	06/02/2022 11:00:15 AM Central Daylight Time					06/05/2022 05:22:56 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	2023	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	4	1				0	0	06/02/2022	2023.01	06/02/2022 11:00:26 AM Central Daylight Time					06/05/2022 05:22:56 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	2023	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	8	1					1	08/03/2022	2023.01	08/03/2022 01:57:25 PM Central Daylight Time	08/03/2022 04:57:08 PM Central Daylight Time	08/02/2022 04:49:02 PM Central Daylight Time			08/04/2022 01:57:51 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Plus (HMO)	01	01		1			H4675	001	0	2023	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	3	1				0	0	06/02/2022	2023.01	06/02/2022 10:07:27 PM Central Daylight Time					06/06/2022 01:53:24 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	2023	New Jersey		1	24	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	3	1						06/02/2022	2023.01	06/02/2022 10:07:43 PM Central Daylight Time					06/06/2022 01:53:24 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	2023	New Jersey		1	2341	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	804	0	1	02	01	H4675_804_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 10:07:56 PM Central Daylight Time					06/06/2022 01:53:24 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Access Group (HMO-POS)	01	02		1			H4675	804	0	2023	New Jersey		1	240	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	805	0	1	02	01	H4675_805_0	3	1						06/02/2022	2023.01	06/02/2022 10:08:11 PM Central Daylight Time					06/06/2022 01:53:24 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	805	0	2023	New Jersey		1	240	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	11	1			2		1	09/16/2022	2023.01	09/16/2022 03:10:02 PM Eastern Daylight Time	09/16/2022 03:35:37 PM Eastern Daylight Time	09/16/2022 03:35:37 PM Eastern Daylight Time			09/16/2022 03:36:38 PM Eastern Daylight Time	TROY HEALTH, INC.	Troy Medicare	www.troymedicare.com	Troy Medicare (HMO)	01	01		1			H4676	001	0	2023	Fayetteville and Mooresville Regions		2		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	9	1	2	1	1		0	09/16/2022	2023.01	09/16/2022 03:10:07 PM Eastern Daylight Time	09/16/2022 03:35:38 PM Eastern Daylight Time	09/16/2022 03:35:38 PM Eastern Daylight Time			09/16/2022 03:36:38 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	2023	Fayetteville and Mooresville Regions		2		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					2					2	2			
H4699	001	0	1	04	01	H4699_001_0	4	1						08/02/2022	2023.01	08/02/2022 09:37:43 AM Eastern Daylight Time	08/03/2022 07:10:05 PM Central Daylight Time	07/30/2022 08:17:39 AM Central Daylight Time			08/04/2022 04:08:52 PM Central 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	2023	All counties in RI		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:26:28 PM Eastern Daylight Time	08/03/2022 07:11:12 PM Central Daylight Time	07/30/2022 08:18:10 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H4699	002	0	2023	All counties in RI		2		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	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:22:18 PM Central Daylight Time	08/03/2022 07:12:23 PM Central Daylight Time	07/30/2022 08:18:42 AM Central Daylight Time			08/04/2022 04:08:52 PM Central 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	2023	All counties in RI		2		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	4	1						07/14/2022	2023.01	07/14/2022 08:31:28 PM Central Daylight Time	08/03/2022 07:13:33 PM Central Daylight Time	07/30/2022 08:19:14 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H4699	004	0	2023	All counties in RI		2		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	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:25:17 PM Central Daylight Time	08/03/2022 07:14:48 PM Central Daylight Time	07/30/2022 08:19:46 AM Central Daylight Time			08/04/2022 04:08:52 PM Central 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	2023	All counties in RI		2		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	3	1				0	0	05/29/2022	2023.01	05/29/2022 03:42:12 PM Eastern Daylight Time	06/03/2022 06:46:32 PM Central Daylight Time				07/15/2022 02:52:59 PM Central 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	2023	All counties in RI		2		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			
H4711	001	0	1	02	01	H4711_001_0	3	1			2			08/02/2022	2023.01	08/02/2022 05:44:29 PM Eastern Daylight Time	08/02/2022 02:39:49 PM Eastern Daylight Time	07/31/2022 10:59:46 PM Eastern Daylight Time			08/04/2022 06:18:03 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	2023	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	3	1			2			08/02/2022	2023.01	08/02/2022 05:44:53 PM Eastern Daylight Time	08/02/2022 02:40:59 PM Eastern Daylight Time	07/31/2022 11:00:14 PM Eastern Daylight Time			08/04/2022 06:18:03 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	2023	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			2			08/02/2022	2023.01	08/02/2022 05:45:53 PM Eastern Daylight Time	08/02/2022 02:42:02 PM Eastern Daylight Time	07/31/2022 11:00:40 PM Eastern Daylight Time			08/04/2022 06:18:03 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	2023	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						08/01/2022	2023.01	08/01/2022 01:05:02 PM Central Daylight Time	08/02/2022 12:53:31 PM Central Daylight Time	07/31/2022 10:01:06 PM Central Daylight Time			08/04/2022 09:41:18 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite 1 (HMO-POS)	01	02		1			H4711	006	0	2023	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						08/01/2022	2023.01	08/01/2022 01:05:24 PM Central Daylight Time	08/02/2022 12:54:20 PM Central Daylight Time	07/31/2022 10:01:30 PM Central Daylight Time			08/04/2022 09:41:18 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite 2 (HMO-POS)	01	02		1			H4711	007	0	2023	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						08/01/2022	2023.01	08/01/2022 01:09:12 PM Central Daylight Time	08/02/2022 12:55:16 PM Central Daylight Time	07/31/2022 10:01:56 PM Central Daylight Time			08/04/2022 09:41:18 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 1 (HMO-POS)	01	02		1			H4711	008	0	2023	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						08/01/2022	2023.01	08/01/2022 01:09:35 PM Central Daylight Time	08/02/2022 12:56:06 PM Central Daylight Time	07/31/2022 10:02:22 PM Central Daylight Time			08/04/2022 09:41:18 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 2 (HMO-POS)	01	02		1			H4711	009	0	2023	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				0	0	05/31/2022	2023.01	05/31/2022 08:22:00 PM Central Daylight Time	06/01/2022 12:54:24 PM Central Daylight Time				06/02/2022 03:10:36 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO-POS)	01	02		1			H4711	010	0	2023	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	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:34:24 PM Eastern Daylight Time	08/02/2022 02:43:05 PM Eastern Daylight Time	07/31/2022 11:02:48 PM Eastern Daylight Time			08/04/2022 06:18:03 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:48:25 PM Central Daylight Time	08/02/2022 12:57:43 PM Central Daylight Time	07/31/2022 10:03:14 PM Central Daylight Time			08/04/2022 10:17:20 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier (HMO D-SNP)	01	01		1			H4711	012	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	013	0	1	01	01	H4711_013_0	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 06:48:40 PM Eastern Daylight Time	08/02/2022 02:44:15 PM Eastern Daylight Time	07/31/2022 11:03:40 PM Eastern Daylight Time			08/05/2022 10:28:02 AM 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	2023	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	05/27/2022	2023.01	05/27/2022 04:02:04 PM Eastern Daylight Time					06/02/2022 03:23:35 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	2023	Colorado and Nevada		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H4711	802	0	1	01	01	H4711_802_0	1	1						05/27/2022	2023.01	05/27/2022 04:04:17 PM Eastern Daylight Time					06/02/2022 03:23:35 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	2023	Colorado and Nevada		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H4714	001	0	1	20	08	H4714_001_0	1	1						06/01/2022	2023.01	06/01/2022 03:34:40 PM Eastern Daylight Time		06/01/2022 03:01:50 PM Eastern Daylight Time			06/01/2022 03:58:19 PM 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	2023	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						06/01/2022	2023.01	06/01/2022 03:35:09 PM Eastern Daylight Time		06/01/2022 03:02:07 PM Eastern Daylight Time			06/01/2022 03:58:19 PM 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	2023	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															
H4733	001	0	1	01	01	H4733_001_0	10	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 07:07:28 PM Pacific Daylight Time	08/04/2022 12:31:01 PM Pacific Daylight Time	08/04/2022 12:31:01 PM Pacific Daylight Time			08/04/2022 12:31:38 PM Pacific Daylight Time	COMMUNITY HEALTH GROUP	Community Health Group	www.chgsd.com	CommuniCare Advantage (HMO SNP) (HMO D-SNP)	01	01		1			H4733	001	0	2023	San Diego County California		2		2			1	3		1					1	https://www.chgsd.com/chg-plans/cmc	https://www.chgsd.com/chg-plans/cmc	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		2					2					2	2			
H4739	001	0	1	01	01	H4739_001_0	7	1	2	1			0	08/09/2022	2023.01	08/09/2022 01:42:08 PM Eastern Daylight Time	08/09/2022 01:38:38 PM Eastern Daylight Time	08/04/2022 11:08:03 AM Eastern Daylight Time			08/09/2022 01:45:15 PM Eastern 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	2023	Majority of SC Counties		2		2			1	3		1					1	www.firstchoicevipcare.com	www.firstchoicevipcare.com	www.firstchoicevipcare.com	(888)996-0499		(888)996-0499		(833)961-3723		(833)961-3723		(888)996-0499		(888)996-0499		(833)961-3723		(833)961-3723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4754	004	0	1	04	01	H4754_004_0	4	1						06/04/2022	2023.01	06/04/2022 07:44:49 PM Pacific Daylight Time	08/02/2022 12:04:57 PM Pacific Daylight Time	08/02/2022 03:15:58 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	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	07/12/2022	2023.01	07/12/2022 08:02:50 AM Pacific Daylight Time	06/05/2022 06:55:55 PM Pacific Daylight Time				07/12/2022 11:27:47 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 6 (PPO)	01	04		1			H4754	006	0	2023	Select Idaho and Montana 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		(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						06/04/2022	2023.01	06/04/2022 07:44:37 PM Pacific Daylight Time	08/02/2022 12:05:27 PM Pacific Daylight Time	08/02/2022 03:16:20 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Oregon 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	2	1				0	0	06/04/2022	2023.01	06/04/2022 07:44:30 PM Pacific Daylight Time	06/05/2022 06:57:07 PM Pacific Daylight Time				06/05/2022 08:16:45 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	2023	Select Oregon 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	5	1						08/04/2022	2023.01	08/04/2022 08:07:11 AM Pacific Daylight Time	08/03/2022 05:06:10 PM Pacific Daylight Time	08/02/2022 03:16:44 PM Pacific Daylight Time			08/04/2022 08:13:05 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 9 (PPO)	01	04		1			H4754	009	0	2023	Select Idaho 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		(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						08/02/2022	2023.01	08/02/2022 01:29:19 PM Pacific Daylight Time	08/02/2022 12:06:21 PM Pacific Daylight Time	08/02/2022 03:17:06 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	Select Idaho and Washington 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		(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	07/12/2022	2023.01	07/12/2022 08:04:36 AM Pacific Daylight Time	06/05/2022 06:58:55 PM Pacific Daylight Time				07/12/2022 11:27:47 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 12 (PPO)	01	04		1			H4754	012	0	2023	Select Idaho and Washington 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		(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	017	0	1	04	01	H4754_017_0	4	1						06/04/2022	2023.01	06/04/2022 07:44:01 PM Pacific Daylight Time	08/02/2022 12:06:52 PM Pacific Daylight Time	08/02/2022 03:17:30 PM Pacific Daylight Time			08/03/2022 03:44:25 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	2023	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	06/04/2022	2023.01	06/04/2022 07:43:54 PM Pacific Daylight Time					06/05/2022 08:16:45 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	2023	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			
H4754	802	0	1	04	01	H4754_802_0	2	1						06/04/2022	2023.01	06/04/2022 07:43:47 PM Pacific Daylight Time					06/05/2022 08:16:45 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	2023	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			
H4801	001	0	1	04	01	H4801_001_0	6	1						08/05/2022	2023.01	08/05/2022 02:38:13 PM Central Daylight Time	08/05/2022 02:13:22 PM Central Daylight Time	08/03/2022 06:08:52 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	001	0	2023	Dallas Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	002	0	1	04	01	H4801_002_0	6	1						08/05/2022	2023.01	08/05/2022 02:38:39 PM Central Daylight Time	08/05/2022 02:15:08 PM Central Daylight Time	08/03/2022 06:10:11 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	002	0	2023	Houston Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	003	0	1	04	01	H4801_003_0	6	1						08/05/2022	2023.01	08/05/2022 02:48:07 PM Central Daylight Time	08/05/2022 02:16:37 PM Central Daylight Time	08/03/2022 06:11:31 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	003	0	2023	Austin Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	004	0	1	04	01	H4801_004_0	6	1						08/04/2022	2023.01	08/04/2022 09:38:09 AM Central Daylight Time	08/05/2022 02:18:28 PM Central Daylight Time	08/03/2022 06:12:51 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	004	0	2023	San Antonio Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	005	0	1	04	01	H4801_005_0	6	1						08/03/2022	2023.01	08/03/2022 11:26:04 AM Central Daylight Time	08/05/2022 02:19:59 PM Central Daylight Time	08/03/2022 06:14:09 PM Central Daylight Time			08/05/2022 07:22:47 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	005	0	2023	El Paso Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	006	0	1	04	01	H4801_006_0	6	1						08/05/2022	2023.01	08/05/2022 02:33:44 PM Central Daylight Time	08/05/2022 02:21:23 PM Central Daylight Time	08/03/2022 06:15:29 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	006	0	2023	South Texas Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	007	0	1	04	01	H4801_007_0	6	1						08/03/2022	2023.01	08/03/2022 11:10:07 AM Central Daylight Time	08/05/2022 02:23:54 PM Central Daylight Time	08/03/2022 06:16:50 PM Central Daylight Time			08/05/2022 07:58:59 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getblueok.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	007	0	2023	Oklahoma		2		2			2									getbluetx.com/mapd/pharmacies	getblueok.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	008	0	1	04	01	H4801_008_0	7	1						08/03/2022	2023.01	08/03/2022 11:11:07 AM Central Daylight Time	08/05/2022 02:25:23 PM Central Daylight Time	08/03/2022 06:18:09 PM Central Daylight Time			08/05/2022 07:58:59 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getblueok.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	008	0	2023	Tulsa and Surrounding Counties		2		2			2									getblueok.com/mapd/pharmacies	getblueok.com/mapd/druglist	getblueok.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	009	0	1	04	01	H4801_009_0	6	1						08/05/2022	2023.01	08/05/2022 02:34:05 PM Central Daylight Time	08/05/2022 02:26:58 PM Central Daylight Time	08/03/2022 06:19:29 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	009	0	2023	North Texas Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	010	0	1	04	01	H4801_010_0	6	1						08/05/2022	2023.01	08/05/2022 02:35:10 PM Central Daylight Time	08/05/2022 02:28:24 PM Central Daylight Time	08/03/2022 06:20:47 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	010	0	2023	Southeast Texas Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	011	0	1	04	01	H4801_011_0	6	1						08/05/2022	2023.01	08/05/2022 02:35:45 PM Central Daylight Time	08/05/2022 02:29:54 PM Central Daylight Time	08/03/2022 06:22:07 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	011	0	2023	Central Texas Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	012	0	1	04	01	H4801_012_0	6	1						08/05/2022	2023.01	08/05/2022 02:36:19 PM Central Daylight Time	08/05/2022 02:31:34 PM Central Daylight Time	08/03/2022 06:23:26 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	012	0	2023	Northeast Texas Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	013	0	1	04	01	H4801_013_0	5	1						06/05/2022	2023.01	06/05/2022 09:55:42 PM Central Daylight Time	08/05/2022 02:33:16 PM Central Daylight Time	08/03/2022 06:24:45 PM Central Daylight Time			08/05/2022 07:58:59 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getblueok.com/mapd	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H4801	013	0	2023	Oklahoma		2		2			2									getblueok.com/mapd/pharmacies	getblueok.com/mapd/druglist	getblueok.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	014	0	1	04	01	H4801_014_0	5	1						08/03/2022	2023.01	08/03/2022 05:10:33 PM Central Daylight Time	08/05/2022 02:35:37 PM Central Daylight Time	08/03/2022 06:26:04 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H4801	014	0	2023	Texas Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	015	0	1	04	01	H4801_015_0	6	1						08/05/2022	2023.01	08/05/2022 02:36:58 PM Central Daylight Time	08/05/2022 02:43:01 PM Central Daylight Time	08/03/2022 06:27:24 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Saver Plus (PPO)	01	04		1			H4801	015	0	2023	Dallas Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	016	0	1	04	01	H4801_016_0	6	1						08/05/2022	2023.01	08/05/2022 02:37:27 PM Central Daylight Time	08/05/2022 02:45:35 PM Central Daylight Time	08/03/2022 06:28:44 PM Central Daylight Time			08/05/2022 08:24:39 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Dental Premier (PPO)	01	04		1			H4801	016	0	2023	Texas		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	017	0	1	04	01	H4801_017_0	6	1						08/03/2022	2023.01	08/03/2022 05:11:46 PM Central Daylight Time	08/05/2022 02:47:05 PM Central Daylight Time	08/03/2022 06:30:04 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	017	0	2023	West Texas		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	018	0	1	04	01	H4801_018_0	6	1						08/05/2022	2023.01	08/05/2022 02:37:58 PM Central Daylight Time	08/05/2022 02:49:14 PM Central Daylight Time	08/03/2022 06:31:25 PM Central Daylight Time			08/05/2022 07:45:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Health Choice (PPO)	01	04		1			H4801	018	0	2023	Texas		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4801	019	0	1	04	01	H4801_019_0	5	1				0	0	07/05/2022	2023.01	07/05/2022 02:28:06 PM Central Daylight Time	06/05/2022 10:13:14 AM Central Daylight Time				07/13/2022 02:59:11 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Protect (PPO)	01	04		1			H4801	019	0	2023	Texas		2		2			2									getbluetx.com/mapd/pharmacies	www.myprime.com	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4801	020	0	1	04	01	H4801_020_0	5	1				0	0	07/05/2022	2023.01	07/05/2022 11:08:10 AM Central Daylight Time	06/05/2022 10:14:43 AM Central Daylight Time				07/13/2022 01:37:28 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getblueok.com/mapd	Blue Cross Medicare Advantage Protect (PPO)	01	04		1			H4801	020	0	2023	Oklahoma		2		2			2									getblueok.com/mapd/pharmacies	www.myprime.com	getblueok.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4801	021	0	1	04	01	H4801_021_0	8	1						08/04/2022	2023.01	08/04/2022 10:10:12 AM Central Daylight Time	08/05/2022 02:54:52 PM Central Daylight Time	08/03/2022 06:32:45 PM Central Daylight Time			08/05/2022 07:58:59 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getblueok.com/mapd	Blue Cross Medicare Advantage Dental Premier (PPO)	01	04		1			H4801	021	0	2023	Oklahoma		2		2			2									getblueok.com/mapd/pharmacies	getblueok.com/mapd/druglist	getblueok.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4808	001	0	1	04	01	H4808_001_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:10:50 PM US Eastern Daylight Time	08/04/2022 09:47:20 AM Eastern Daylight Time	07/31/2022 01:49:55 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Devoted Health	www.Devoted.com	Devoted CHOICE Colorado (PPO)	01	04		1			H4808	001	0	2023	El Paso, Teller, Larimer, and Weld 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			
H4808	002	0	1	04	01	H4808_002_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:11:07 PM US Eastern Daylight Time	08/04/2022 09:47:45 AM Eastern Daylight Time	07/31/2022 01:50:17 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Devoted Health	www.Devoted.com	Devoted CHOICE Colorado (PPO)	01	04		1			H4808	002	0	2023	Denver		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			
H4829	003	0	1	04	01	H4829_003_0	3	1					1	08/04/2022	2023.01	08/04/2022 01:53:06 PM Central Daylight Time	08/03/2022 11:00:49 AM Central Daylight Time	07/31/2022 02:50:16 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H4829	003	0	2023	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	08/02/2022	2023.01	08/02/2022 01:35:29 PM Central Daylight Time	08/03/2022 11:01:26 AM Central Daylight Time	07/31/2022 02:50:41 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H4829	004	0	2023	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	3	1					1	05/30/2022	2023.01	05/30/2022 02:34:43 PM Central Daylight Time	08/03/2022 11:02:03 AM Central Daylight Time	07/31/2022 02:51:06 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H4829	005	0	2023	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	008	0	1	04	01	H4829_008_0	3	1					1	05/30/2022	2023.01	05/30/2022 02:36:33 PM Central Daylight Time	08/03/2022 11:02:40 AM Central Daylight Time	07/31/2022 02:51:30 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H4829	008	0	2023	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			
H4829	010	0	1	04	01	H4829_010_0	3	1					1	05/30/2022	2023.01	05/30/2022 02:38:18 PM Central Daylight Time	08/03/2022 11:03:17 AM Central Daylight Time	07/31/2022 02:51:54 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H4829	010	0	2023	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			
H4829	011	0	1	04	01	H4829_011_0	3	1					1	06/02/2022	2023.01	06/02/2022 08:31:37 AM Central Daylight Time	08/03/2022 11:03:53 AM Central Daylight Time	07/31/2022 02:52:19 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H4829	011	0	2023	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			
H4829	012	0	1	04	01	H4829_012_0	3	1					1	05/30/2022	2023.01	05/30/2022 02:44:01 PM Central Daylight Time	08/03/2022 11:04:31 AM Central Daylight Time	07/31/2022 02:52:43 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H4829	012	0	2023	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			
H4829	013	0	1	04	01	H4829_013_0	3	1					1	08/03/2022	2023.01	08/03/2022 08:29:12 AM Central Daylight Time	08/03/2022 11:05:09 AM Central Daylight Time	07/31/2022 02:53:08 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H4829	013	0	2023	Los Angeles 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	014	0	1	04	01	H4829_014_0	3	1					1	08/03/2022	2023.01	08/03/2022 08:31:21 AM Central Daylight Time	08/03/2022 11:05:47 AM Central Daylight Time	07/31/2022 02:53:33 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H4829	014	0	2023	Orange 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	015	0	1	04	01	H4829_015_0	3	1					1	08/03/2022	2023.01	08/03/2022 08:34:38 AM Central Daylight Time	08/03/2022 11:06:25 AM Central Daylight Time	07/31/2022 02:53:57 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H4829	015	0	2023	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			
H4829	016	0	1	04	01	H4829_016_0	3	1					1	08/02/2022	2023.01	08/02/2022 01:37:36 PM Central Daylight Time	08/03/2022 11:07:03 AM Central Daylight Time	07/31/2022 02:54:21 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H4829	016	0	2023	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	017	0	1	04	01	H4829_017_0	3	1					1	08/02/2022	2023.01	08/02/2022 01:38:19 PM Central Daylight Time	08/03/2022 11:07:40 AM Central Daylight Time	07/31/2022 02:54:46 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H4829	017	0	2023	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	018	0	1	04	01	H4829_018_0	3	1					1	08/02/2022	2023.01	08/02/2022 01:39:11 PM Central Daylight Time	08/03/2022 11:08:16 AM Central Daylight Time	07/31/2022 02:55:11 AM Central Daylight Time			08/04/2022 03:43:23 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H4829	018	0	2023	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			
H4835	001	0	1	02	01	H4835_001_0	4	1						08/02/2022	2023.01	08/02/2022 01:46:08 PM Eastern Daylight Time	08/02/2022 02:08:36 PM Eastern Daylight Time	07/31/2022 11:04:06 PM Eastern Daylight Time			08/04/2022 05:35:21 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	2023	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	3	1						08/02/2022	2023.01	08/02/2022 01:46:23 PM Eastern Daylight Time	08/02/2022 02:09:30 PM Eastern Daylight Time	07/31/2022 11:04:32 PM Eastern Daylight Time			08/04/2022 05:35:21 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	2023	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	3	1						08/02/2022	2023.01	08/02/2022 01:46:37 PM Eastern Daylight Time	08/02/2022 02:10:30 PM Eastern Daylight Time	07/31/2022 11:04:58 PM Eastern Daylight Time			08/04/2022 05:35:21 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	2023	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	3	1						08/02/2022	2023.01	08/02/2022 01:46:51 PM Eastern Daylight Time	08/02/2022 02:11:34 PM Eastern Daylight Time	07/31/2022 11:05:26 PM Eastern Daylight Time			08/04/2022 05:35:21 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	2023	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	3	1						08/02/2022	2023.01	08/02/2022 01:47:06 PM Eastern Daylight Time	08/02/2022 02:12:39 PM Eastern Daylight Time	07/31/2022 11:05:52 PM Eastern Daylight Time			08/04/2022 05:35:21 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	2023	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						08/02/2022	2023.01	08/02/2022 01:47:45 PM Eastern Daylight Time	08/02/2022 02:13:42 PM Eastern Daylight Time	07/31/2022 11:06:18 PM Eastern Daylight Time			08/04/2022 05:35:21 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	2023	Cochise, Gila, Graham and Santa Cruz 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	801	0	1	01	01	H4835_801_0	1	1				0	0	05/27/2022	2023.01	05/27/2022 04:09:30 PM Eastern Daylight Time					06/02/2022 03:25:02 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	2023	Arizona		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H4835	802	0	1	01	01	H4835_802_0	1	1						05/30/2022	2023.01	05/30/2022 11:18:44 AM Eastern Daylight Time					06/02/2022 03:25:02 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	2023	Arizona		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H4847	001	0	1	01	01	H4847_001_0	4	1						08/01/2022	2023.01	08/01/2022 12:41:03 PM Eastern Daylight Time	08/03/2022 07:56:45 PM Central Daylight Time	07/30/2022 08:20:17 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H4847	001	0	2023	Select counties in SC		2		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	6	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 01:00:36 PM Eastern Daylight Time	08/03/2022 07:58:23 PM Central Daylight Time	07/30/2022 08:20:50 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H4847	004	0	2023	Select counties in SC		2		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						05/26/2022	2023.01	05/26/2022 11:46:24 AM Eastern Daylight Time	08/03/2022 07:59:56 PM Central Daylight Time	07/30/2022 08:21:21 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H4847	005	0	2023	All counties in SC		2		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	05/26/2022	2023.01	05/26/2022 11:48:06 AM Eastern Daylight Time	06/03/2022 06:00:27 PM Central Daylight Time				07/15/2022 03:18:19 PM Central Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback (HMO-POS)	01	02		1			H4847	006	0	2023	All counties in SC		2		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			
H4863	001	0	1	01	01	H4863_001_0	6	1					1	08/03/2022	2023.01	08/03/2022 10:16:42 PM India Standard Time	08/03/2022 10:26:03 AM Central Daylight Time	08/02/2022 04:37:21 PM Central Daylight Time			08/03/2022 02:28:05 PM Central Daylight Time	TRH HEALTH INSURANCE COMPANY	Farm Bureau Health Plans	https://fbhp.com	Farm Bureau Advantage (HMO)	01	01		1			H4863	001	0	2023	Central TN		2		2			2									www.fbhp.com	www.fbhp.com		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4863	003	0	1	01	01	H4863_003_0	6	1					1	08/03/2022	2023.01	08/03/2022 10:16:33 PM India Standard Time	08/03/2022 10:27:35 AM Central Daylight Time	08/02/2022 04:39:26 PM Central Daylight Time			08/03/2022 02:28:05 PM Central Daylight Time	TRH HEALTH INSURANCE COMPANY	Farm Bureau Health Plans	https://fbhp.com	Farm Bureau Advantage (HMO)	01	01		1			H4863	003	0	2023	Tri-City		2		2			2									www.fbhp.com	www.fbhp.com		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4863	005	0	1	01	01	H4863_005_0	6	1					1	08/03/2022	2023.01	08/03/2022 10:16:13 PM India Standard Time	08/03/2022 10:28:45 AM Central Daylight Time	08/02/2022 04:41:10 PM Central Daylight Time			08/03/2022 02:28:05 PM Central Daylight Time	TRH HEALTH INSURANCE COMPANY	Farm Bureau Health Plans	https://fbhp.com	Farm Bureau Advantage (HMO)	01	01		1			H4863	005	0	2023	Knoxville		2		2			2									www.fbhp.com	www.fbhp.com		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(111)111-1111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	003	0	1	01	01	H4868_003_0	3	1				0	0	05/25/2022	2023.01	05/25/2022 10:12:08 PM Eastern Daylight Time	06/03/2022 07:37:13 PM Eastern Daylight Time				07/15/2022 04:17:33 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	2023	Select counties in NY		2		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	1		0	07/05/2022	2023.01	07/05/2022 11:54:53 AM Eastern Daylight Time	08/03/2022 07:55:41 PM Eastern Daylight Time	07/30/2022 09:21:53 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	1		0	07/05/2022	2023.01	07/05/2022 12:00:28 PM Eastern Daylight Time	08/03/2022 07:56:52 PM Eastern Daylight Time	07/30/2022 09:22:25 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		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	4	1						05/25/2022	2023.01	05/25/2022 10:17:01 PM Eastern Daylight Time	08/03/2022 07:58:04 PM Eastern Daylight Time	07/30/2022 09:22:57 AM Eastern Daylight Time			08/04/2022 05:30:37 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H4868	016	0	2023	Select counties in NY		2		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	4	1						08/03/2022	2023.01	08/03/2022 03:04:37 PM Eastern Daylight Time	08/03/2022 07:59:14 PM Eastern Daylight Time	07/30/2022 09:23:29 AM Eastern Daylight Time			08/04/2022 05:30:37 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H4868	019	0	2023	Select counties in NY		2		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			
H4869	001	0	1	01	01	H4869_001_0	7	1		1			1	08/04/2022	2023.01	08/04/2022 10:36:43 AM Eastern Daylight Time	08/04/2022 11:39:31 AM Eastern Daylight Time	08/04/2022 12:08:20 PM Eastern Daylight Time			08/04/2022 02:07:05 PM Eastern Daylight Time	GOLD KIDNEY OF ARIZONA	Gold Kidney of Arizona	goldkidney.com	Super Plus (HMO C-SNP)	01	01		1			H4869	001	0	2023	Maricopa, Pinal, Pima and Gila counties		2		2			1	4			00000000000000000010000					https://goldkidney.com/2023-care-directory	https://goldkidney.com/2023-formulary	https://goldkidney.com/providers	(844)294-6535		(480)870-7007		(844)294-6535		(480)870-7007		(888)672-7206		(888)672-7206		(888)672-7206		(888)672-7206		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4869	002	0	1	01	01	H4869_002_0	8	1		1			0	08/04/2022	2023.01	08/04/2022 10:12:35 AM Eastern Daylight Time	08/04/2022 11:48:47 AM Eastern Daylight Time	08/04/2022 12:13:42 PM Eastern Daylight Time			08/04/2022 02:07:05 PM Eastern Daylight Time	GOLD KIDNEY OF ARIZONA	Gold Kidney of Arizona	goldkidney.com	Super Complete (HMO C-SNP)	01	01		1			H4869	002	0	2023	Maricopa, Pinal, Pima and Gila counties		2		2			1	4			00000000000000000010000					https://goldkidney.com/2023-care-directory	https://goldkidney.com/2023-formulary	https://goldkidney.com/providers	(844)294-6535		(480)870-7007		(844)294-6535		(480)870-7007		(888)672-7206		(888)672-7206		(888)672-7206		(888)672-7206		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4869	003	0	1	02	01	H4869_003_0	8	1		1			1	08/17/2022	2023.01	08/17/2022 03:31:59 PM Eastern Daylight Time		08/04/2022 12:19:01 PM Eastern Daylight Time		08/04/2022 11:50:52 AM Eastern Daylight Time	08/17/2022 05:16:45 PM Eastern Daylight Time	GOLD KIDNEY OF ARIZONA	Gold Kidney of Arizona	goldkidney.com	Dialysis Plus (HMO-POS C-SNP)	01	02		1			H4869	003	0	2023	Maricopa, Pinal, Pima and Gila counties		2		2			1	4			00000000100000000000000					https://goldkidney.com/2023-care-directory	https://goldkidney.com/2023-formulary	https://goldkidney.com/providers	(844)294-6535		(480)870-7007		(844)294-6535		(480)870-7007		(888)672-7206		(888)672-7206		(888)672-7206		(888)672-7206		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4869	004	0	1	02	01	H4869_004_0	10	1		1			0	08/17/2022	2023.01	08/17/2022 03:07:07 PM Eastern Daylight Time		08/04/2022 12:24:11 PM Eastern Daylight Time		08/04/2022 11:53:14 AM Eastern Daylight Time	08/17/2022 05:16:45 PM Eastern Daylight Time	GOLD KIDNEY OF ARIZONA	Gold Kidney of Arizona	goldkidney.com	Dialysis Complete (HMO-POS C-SNP)	01	02		1			H4869	004	0	2023	Maricopa, Pinal, Pima and Gila counties		2		2			1	4			00000000100000000000000					https://goldkidney.com/2023-care-directory	https://goldkidney.com/2023-formulary	https://goldkidney.com/providers	(844)294-6535		(480)870-7007		(844)294-6535		(480)870-7007		(888)672-7206		(888)672-7206		(888)672-7206		(888)672-7206		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4869	005	0	1	01	01	H4869_005_0	7	1					1	08/04/2022	2023.01	08/04/2022 10:15:57 AM Eastern Daylight Time	08/04/2022 12:01:25 PM Eastern Daylight Time	08/04/2022 12:29:41 PM Eastern Daylight Time			08/04/2022 02:07:05 PM Eastern Daylight Time	GOLD KIDNEY OF ARIZONA	Gold Kidney of Arizona	goldkidney.com	Honest Care (HMO)	01	01		1			H4869	005	0	2023	Maricopa, Pinal, Pima and Gila counties		2		2			2									https://goldkidney.com/2023-care-directory	https://goldkidney.com/2023-formulary	https://goldkidney.com/providers	(844)294-6535		(480)870-7007		(844)294-6535		(480)870-7007		(888)672-7206		(888)672-7206		(888)672-7206		(888)672-7206		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4875	016	1	1	04	01	H4875_016_1	12	1						07/18/2022	2023.01	07/18/2022 10:29:37 PM Eastern Daylight Time	08/04/2022 12:41:46 PM Eastern Daylight Time	07/31/2022 07:27:44 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	1	2023	68 lower peninsula Michigan counties	Region 3	2		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	12	1						07/18/2022	2023.01	07/18/2022 10:30:29 PM Eastern Daylight Time	08/04/2022 12:42:10 PM Eastern Daylight Time	07/31/2022 07:28:04 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	2	2023	68 lower peninsula Michigan counties	Region 4	2		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	12	1						07/18/2022	2023.01	07/18/2022 10:30:38 PM Eastern Daylight Time	08/04/2022 12:42:36 PM Eastern Daylight Time	07/31/2022 07:28:22 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	3	2023	68 lower peninsula Michigan counties	Region 5	2		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	12	1						07/18/2022	2023.01	07/18/2022 10:30:48 PM Eastern Daylight Time	08/04/2022 12:43:02 PM Eastern Daylight Time	07/31/2022 07:28:40 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	4	2023	68 lower peninsula Michigan counties	Region 1	2		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	12	1						07/18/2022	2023.01	07/18/2022 10:30:57 PM Eastern Daylight Time	08/04/2022 12:43:28 PM Eastern Daylight Time	07/31/2022 07:29:00 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	5	2023	68 lower peninsula Michigan counties	Region 2	2		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	12	1						07/18/2022	2023.01	07/18/2022 10:34:55 PM Eastern Daylight Time	08/04/2022 12:43:52 PM Eastern Daylight Time	07/31/2022 07:29:18 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	1	2023	68 lower peninsula Michigan counties	Region 1	2		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	12	1						07/18/2022	2023.01	07/18/2022 10:35:52 PM Eastern Daylight Time	08/04/2022 12:44:18 PM Eastern Daylight Time	07/31/2022 07:29:36 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	2	2023	68 lower peninsula Michigan counties	Region 2	2		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	12	1						07/18/2022	2023.01	07/18/2022 10:36:02 PM Eastern Daylight Time	08/04/2022 12:44:46 PM Eastern Daylight Time	07/31/2022 07:29:54 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	3	2023	68 lower peninsula Michigan counties	Region 3	2		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	14	1						07/18/2022	2023.01	07/18/2022 10:36:11 PM Eastern Daylight Time	08/04/2022 12:45:12 PM Eastern Daylight Time	07/31/2022 07:30:12 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	4	2023	68 lower peninsula Michigan counties	Region 4	2		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	14	1						07/18/2022	2023.01	07/18/2022 10:36:21 PM Eastern Daylight Time	08/04/2022 12:45:38 PM Eastern Daylight Time	07/31/2022 07:30:30 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	5	2023	68 lower peninsula Michigan counties	Region 5	2		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	12	1						08/03/2022	2023.01	08/03/2022 08:20:15 PM Eastern Daylight Time	08/04/2022 12:46:04 PM Eastern Daylight Time	07/31/2022 07:30:48 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	1	2023	68 lower peninsula Michigan counties	Region 1	2		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	12	1						08/03/2022	2023.01	08/03/2022 08:22:27 PM Eastern Daylight Time	08/04/2022 12:46:30 PM Eastern Daylight Time	07/31/2022 07:31:06 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	2	2023	68 lower peninsula Michigan counties	Region 2	2		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	12	1						08/03/2022	2023.01	08/03/2022 08:22:57 PM Eastern Daylight Time	08/04/2022 12:46:56 PM Eastern Daylight Time	07/31/2022 07:31:26 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	3	2023	68 lower peninsula Michigan counties	Region 3	2		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	12	1						08/03/2022	2023.01	08/03/2022 08:23:22 PM Eastern Daylight Time	08/04/2022 12:47:22 PM Eastern Daylight Time	07/31/2022 07:31:44 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	4	2023	68 lower peninsula Michigan counties	Region 4	2		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	12	1						08/03/2022	2023.01	08/03/2022 08:23:51 PM Eastern Daylight Time	08/04/2022 12:47:46 PM Eastern Daylight Time	07/31/2022 07:32:02 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	5	2023	68 lower peninsula Michigan counties	Region 5	2		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	12	1						08/03/2022	2023.01	08/03/2022 03:16:16 PM Eastern Daylight Time	08/04/2022 12:48:14 PM Eastern Daylight Time	07/31/2022 07:32:20 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Edge (PPO)	01	04		1			H4875	020	1	2023	West, SW, & SE counties, lower MI	Region 1	2		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	12	1						08/03/2022	2023.01	08/03/2022 03:17:44 PM Eastern Daylight Time	08/04/2022 12:48:40 PM Eastern Daylight Time	07/31/2022 07:32:38 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Edge (PPO)	01	04		1			H4875	020	2	2023	West, SW, & SE counties, lower MI	Region 2	2		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	12	1						08/03/2022	2023.01	08/03/2022 03:19:03 PM Eastern Daylight Time	08/04/2022 12:49:04 PM Eastern Daylight Time	07/31/2022 07:32:56 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Edge (PPO)	01	04		1			H4875	020	3	2023	West, SW, & SE counties, lower MI	Region 5	2		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	12	1						08/03/2022	2023.01	08/03/2022 03:38:53 PM Eastern Daylight Time	08/04/2022 12:49:30 PM Eastern Daylight Time	07/31/2022 07:33:16 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Compass (PPO)	01	04		1			H4875	021	1	2023	North counties, lower MI	Region 3	2		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	12	1						08/03/2022	2023.01	08/03/2022 03:42:47 PM Eastern Daylight Time	08/04/2022 12:49:54 PM Eastern Daylight Time	07/31/2022 07:33:34 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Compass (PPO)	01	04		1			H4875	021	2	2023	North counties, lower MI	Region 4	2		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	14	1						08/03/2022	2023.01	08/03/2022 08:34:35 PM Eastern Daylight Time	08/04/2022 05:34:46 PM Eastern Daylight Time	07/31/2022 07:33:52 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Vital (PPO)	01	04		1			H4875	022	1	2023	West, SW, and SE counties	Region 1	2		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	14	1						08/03/2022	2023.01	08/03/2022 08:37:38 PM Eastern Daylight Time	08/04/2022 05:35:12 PM Eastern Daylight Time	07/31/2022 07:34:10 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Vital (PPO)	01	04		1			H4875	022	2	2023	West, SW, and SE counties	Region 2	2		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	13	1						08/03/2022	2023.01	08/03/2022 08:39:32 PM Eastern Daylight Time	08/04/2022 05:35:36 PM Eastern Daylight Time	07/31/2022 07:34:28 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Vital (PPO)	01	04		1			H4875	022	5	2023	West, SW, and SE counties	Region 5	2		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	023	0	1	04	01	H4875_023_0	13	1					0	08/03/2022	2023.01	08/03/2022 08:01:25 PM Eastern Daylight Time	08/04/2022 05:36:02 PM Eastern Daylight Time	07/31/2022 07:34:46 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare + Kroger (PPO)	01	04		1			H4875	023	0	2023	GEN, ING, LIV, MAC, OAK, SAG, WASH, WAY counties		2		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	7	1						07/19/2022	2023.01	07/19/2022 03:59:59 PM Eastern Daylight Time					07/19/2022 04:27:01 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	2023	National		1	1044	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	5	1						07/19/2022	2023.01	07/19/2022 04:07:31 PM Eastern Daylight Time					07/19/2022 04:27:01 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare PPO EG Calendar Year (PPO)	01	04		1			H4875	804	0	2023	National		1	58596	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	6	1				0	0	07/19/2022	2023.01	07/19/2022 04:08:28 PM Eastern Daylight Time					07/19/2022 04:27:01 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	2023	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	6	1				0	0	07/19/2022	2023.01	07/19/2022 04:08:40 PM Eastern Daylight Time					07/19/2022 04:27:01 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	2023	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	2	1					1	07/14/2022	2023.01	07/14/2022 03:25:41 PM Central Daylight Time	08/04/2022 09:12:07 AM Central Daylight Time	08/01/2022 08:45:06 AM Central Daylight Time			08/05/2022 01:30:57 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Stride (PPO)	01	04		1			H4882	001	0	2023	Metro and Central MN 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	003	0	1	04	01	H4882_003_0	4	1					1	08/05/2022	2023.01	08/05/2022 09:58:01 AM Central Daylight Time	08/04/2022 09:16:24 AM Central Daylight Time	08/01/2022 08:45:40 AM Central Daylight Time			08/05/2022 01:30:57 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Steady (PPO)	01	04		1			H4882	003	0	2023	Metro and Central MN 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	004	0	1	04	01	H4882_004_0	9	1					1	08/05/2022	2023.01	08/05/2022 10:23:58 AM Central Daylight Time	08/03/2022 12:26:58 PM Central Daylight Time	08/01/2022 08:46:52 AM Central Daylight Time			08/05/2022 01:39:03 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Robin Birch (PPO)	01	04		1			H4882	004	0	2023	Northeastern Wisconsin including Door County		2		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	8	1					1	08/04/2022	2023.01	08/04/2022 04:49:37 PM Central Daylight Time	08/03/2022 12:25:34 PM Central Daylight Time	08/01/2022 08:49:10 AM Central Daylight Time			08/05/2022 01:39:03 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Robin Maple (PPO)	01	04		1			H4882	005	0	2023	Northeastern Wisconsin including Door County		2		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	009	1	1	04	01	H4882_009_1	4	1					1	08/05/2022	2023.01	08/05/2022 10:06:09 AM Central Daylight Time	08/04/2022 09:21:03 AM Central Daylight Time	08/01/2022 08:51:04 AM Central Daylight Time			08/05/2022 01:30:57 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Pace (PPO)	01	04		1			H4882	009	1	2023	Metro, Central, and Greater MN Counties	Metro and Central MN 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	009	2	1	04	01	H4882_009_2	4	1					1	08/05/2022	2023.01	08/05/2022 10:14:49 AM Central Daylight Time	08/04/2022 09:28:26 AM Central Daylight Time	08/01/2022 08:50:22 AM Central Daylight Time			08/05/2022 01:30:57 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Pace (PPO)	01	04		1			H4882	009	2	2023	Metro, Central, and Greater MN Counties	North, West, Southwest and Duluth area	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	010	1	1	04	01	H4882_010_1	2	1					1	08/05/2022	2023.01	08/05/2022 09:55:36 AM Central Daylight Time	08/04/2022 09:31:39 AM Central Daylight Time	08/01/2022 08:52:46 AM Central Daylight Time			08/05/2022 01:30:57 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Dash (PPO)	01	04		1			H4882	010	1	2023	Metro, Central, and Greater MN Counties	Metro and Central MN 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	010	2	1	04	01	H4882_010_2	2	1					1	06/04/2022	2023.01	06/04/2022 10:58:24 AM Central Daylight Time	08/04/2022 09:34:37 AM Central Daylight Time	08/01/2022 08:52:06 AM Central Daylight Time			08/05/2022 01:30:57 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Dash (PPO)	01	04		1			H4882	010	2	2023	Metro, Central, and Greater MN Counties	North, West, Southwest and Duluth area	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	2	1						06/02/2022	2023.01	06/02/2022 09:15:51 AM Central Daylight Time					06/03/2022 10:57:00 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group MAPD Calendar Year (PPO)	01	04		1			H4882	801	0	2023	All States Excluding Cost Counties		1	172013	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	2	1				0	0	06/02/2022	2023.01	06/02/2022 09:16:07 AM Central Daylight Time					06/03/2022 10:57:00 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group MA Only (PPO)	01	04		1			H4882	803	0	2023	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	2	1						05/26/2022	2023.01	05/26/2022 03:55:42 PM Central Daylight Time					06/03/2022 10:57:00 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group II MAPD Calendar Year (PPO)	01	04		1			H4882	804	0	2023	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	2	1				0	0	06/02/2022	2023.01	06/02/2022 09:14:33 AM Central Daylight Time					06/03/2022 10:57:00 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group II MA Only (PPO)	01	04		1			H4882	805	0	2023	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	806	0	1	04	01	H4882_806_0	2	1						06/02/2022	2023.01	06/02/2022 09:14:15 AM Central Daylight Time					06/03/2022 10:57:00 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group III MAPD Calendar Year (PPO)	01	04		1			H4882	806	0	2023	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			
H4909	014	0	1	04	01	H4909_014_0	6	1			2		0	08/01/2022	2023.01	08/01/2022 02:30:53 PM Eastern Daylight Time	08/04/2022 06:21:04 PM Eastern Daylight Time	08/04/2022 06:38:17 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	5	1			2		0	05/26/2022	2023.01	05/26/2022 04:55:07 PM Venezuela Standard Time	08/04/2022 06:17:44 PM Venezuela Standard Time	08/04/2022 06:31:50 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard 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	2023	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	5	1			2		1	08/01/2022	2023.01	08/01/2022 04:36:54 PM Venezuela Standard Time	08/04/2022 06:17:45 PM Venezuela Standard Time	08/04/2022 06:31:53 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard 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	2023	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	8	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 12:46:42 PM Eastern Daylight Time	08/04/2022 06:21:05 PM Eastern Daylight Time	08/04/2022 06:38:20 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1			2	0	0	05/20/2022	2023.01	05/20/2022 04:17:08 PM Eastern Daylight Time	08/04/2022 06:21:07 PM Eastern Daylight Time				08/05/2022 08:46:26 AM 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	2023	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	4	1			2	0	0	05/25/2022	2023.01	05/25/2022 09:49:43 AM Venezuela Standard Time	07/19/2022 05:10:01 PM Venezuela Standard Time				07/19/2022 06:26:52 PM Venezuela Standard 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	2023	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	5	1			2		0	08/04/2022	2023.01	08/04/2022 04:27:55 PM Pacific Daylight Time	08/04/2022 03:20:09 PM Pacific Daylight Time	08/04/2022 03:36:30 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Select Counties in CO		2		2			2									https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)681-2637		(833)681-2637		(855)679-0546		(855)679-0546		(833)341-4609		(833)341-4609		(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	4	1			2	0	0	05/24/2022	2023.01	05/24/2022 11:43:48 AM Eastern Daylight Time	07/19/2022 05:09:09 PM Eastern Daylight Time				07/19/2022 07:50:24 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	2023	Select counties in KY		2		2			2									https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)681-2635		(833)681-2635		(855)768-1041		(855)768-1041										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4909	024	0	1	04	01	H4909_024_0	5	1			2		1	08/01/2022	2023.01	08/01/2022 03:57:40 PM Eastern Daylight Time	08/04/2022 06:17:08 PM Eastern Daylight Time	08/04/2022 06:30:42 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	Select counties in KY		2		2			2									https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)681-2635		(833)681-2635		(855)768-1041		(855)768-1041		(833)341-4609		(833)341-4609		(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	6	1			2		0	08/09/2022	2023.01	08/09/2022 03:34:33 PM Eastern Daylight Time	08/04/2022 06:17:09 PM Eastern Daylight Time	08/04/2022 06:30:45 PM Eastern Daylight Time			08/09/2022 03:43:06 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	2023	Select counties in KY		2		2			2									https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)681-2635		(833)681-2635		(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	08/01/2022	2023.01	08/01/2022 02:30:23 PM Eastern Daylight Time	08/04/2022 06:21:08 PM Eastern Daylight Time	08/04/2022 06:38:23 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	028	0	1	04	01	H4909_028_0	8	1	2	1	1		0	06/29/2022	2023.01	06/29/2022 02:48:18 PM Venezuela Standard Time	08/04/2022 06:17:47 PM Venezuela Standard Time	08/04/2022 06:31:56 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard 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	028	0	2023	Select counties in Missouri		2		2			1	3		1					1	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	804	0	1	04	01	H4909_804_0	2	1						05/23/2022	2023.01	05/23/2022 02:52:38 PM Pacific Daylight Time					06/03/2022 10:33:24 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	2023	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)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;15;16b;18a;	2		1									
H4909	805	0	1	04	01	H4909_805_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:53:44 PM Pacific Daylight Time					06/03/2022 10:33:24 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	2023	National		1	36	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;15;16b;18a;	2		1									
H4909	810	0	2	04	01	H4909_810_0	2	1						05/23/2022	2023.01	05/23/2022 02:53:54 PM Pacific Daylight Time					06/03/2022 10:33:24 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	2023	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;15;16b;18a;	2		1									
H4909	811	0	1	04	01	H4909_811_0	2	1						05/23/2022	2023.01	05/23/2022 02:54:04 PM Pacific Daylight Time					06/03/2022 10:33:24 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	2023	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;15;16b;18a;	2		1									
H4909	812	0	1	04	01	H4909_812_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:54:12 PM Pacific Daylight Time					06/03/2022 10:33:24 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	2023	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;15;16b;18a;	2		1									
H4909	814	0	2	04	01	H4909_814_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:54:19 PM Pacific Daylight Time					06/03/2022 10:33:24 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	2023	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;15;16b;18a;	2		1									
H4909	815	0	2	04	01	H4909_815_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:54:30 PM Pacific Daylight Time					06/03/2022 10:33:24 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	2023	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;15;16b;18a;	2		1									
H4909	817	0	1	04	01	H4909_817_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:54:38 PM Pacific Daylight Time					06/03/2022 10:33:24 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	2023	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;15;16b;18a;	2		1									
H4909	818	0	1	04	01	H4909_818_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 02:54:45 PM Pacific Daylight Time					06/03/2022 10:33:24 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	2023	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;15;16b;18a;	2		1									
H4922	003	0	1	01	01	H4922_003_0	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 01:04:18 PM Eastern Daylight Time	08/05/2022 08:35:28 AM Eastern Daylight Time	08/05/2022 08:35:34 AM Eastern Daylight Time			08/05/2022 08:50:32 AM 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	2023	New York City Metro Area, Nassau, Westchester		2		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	6	1		1				08/04/2022	2023.01	08/04/2022 12:56:10 PM Eastern Daylight Time	08/05/2022 08:34:57 AM Eastern Daylight Time	08/05/2022 08:35:02 AM Eastern Daylight Time			08/05/2022 08:50:32 AM 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	2023	New York City Metro Area, Long Island, Westchester		2		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	6	1	2	1			0	08/04/2022	2023.01	08/04/2022 12:57:35 PM Eastern Daylight Time	08/05/2022 08:35:07 AM Eastern Daylight Time	08/05/2022 08:35:12 AM Eastern Daylight Time			08/05/2022 08:50:32 AM 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	2023	New York City Metro Area, Nassau, Westchester		2		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	7	1						08/04/2022	2023.01	08/04/2022 12:54:04 PM Eastern Daylight Time	08/05/2022 08:35:18 AM Eastern Daylight Time	08/05/2022 08:35:23 AM Eastern Daylight Time			08/05/2022 08:50:32 AM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York LiveWell (HMO)	01	01		1			H4922	011	0	2023	New York City Metro Area, Nassau, Westchester		2		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	007	0	1	01	01	H4931_007_0	9	1	2	1	1		0	08/17/2022	2023.01	08/17/2022 04:49:36 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time			08/17/2022 05:21:00 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	www.BannerHealth.com/Medicare	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	007	0	2023	ACC Central and Southern AZ Counties		2		2			1	3		1					1	www.BannerHealth.com/Medicare	www.BannerHealth.com/Medicare	www.BannerHealth.com/Medicare	(877)874-3930		(520)874-3930		(877)874-3938		(602)560-4782		(877)874-3930		(520)874-3930		(877)874-3938		(602)560-4782		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	015	0	1	01	01	H4931_015_0	9	1	2	1	1		0	08/17/2022	2023.01	08/17/2022 04:54:37 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time			08/17/2022 05:21:00 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	www.BannerHealth.com/Medicare	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	015	0	2023	ALTCS Central and Southern AZ Counties		2		2			1	3		1					1	www.BannerHealth.com/Medicare	www.BannerHealth.com/Medicare	www.BannerHealth.com/Medicare	(877)874-3930		(520)874-3930		(877)874-3938		(602)560-4782		(877)874-3930		(520)874-3930		(877)874-3938		(602)560-4782		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4937	001	0	1	04	01	H4937_001_0	5	1						07/21/2022	2023.01	07/21/2022 03:07:28 PM Pacific Daylight Time	08/03/2022 08:54:37 PM Pacific Daylight Time	08/02/2022 05:08:27 PM Pacific Daylight Time			08/05/2022 08:44:11 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Select (PPO)	01	04		1			H4937	001	0	2023	Alameda County		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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			
H4937	002	0	1	04	01	H4937_002_0	6	1						07/21/2022	2023.01	07/21/2022 03:18:13 PM Pacific Daylight Time	08/03/2022 08:59:20 PM Pacific Daylight Time	08/02/2022 05:09:21 PM Pacific Daylight Time			08/05/2022 08:44:11 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Select (PPO)	01	04		1			H4937	002	0	2023	Orange and San Diego Counties		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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			
H4937	801	0	1	04	01	H4937_801_0	2	1						05/20/2022	2023.01	05/20/2022 11:00:59 AM Pacific Daylight Time					06/03/2022 02:13:23 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Medicare (PPO)	01	04		1			H4937	801	0	2023	MA-PD Employer Group Plan		1	67763	2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	2	1						05/20/2022	2023.01	05/20/2022 11:03:51 AM Pacific Daylight Time					06/03/2022 02:16:51 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Medicare (PPO)	01	04		1			H4937	802	0	2023	MA-PD Employer Group Plan		1	0	2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	803	0	1	04	01	H4937_803_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:01:19 AM Pacific Daylight Time					06/03/2022 02:16:51 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Medicare without Rx (PPO)	01	04		1			H4937	803	0	2023	MA-only Employer Group Plan		1	0	2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:01:44 AM Pacific Daylight Time					06/03/2022 02:16:51 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Medicare without Rx (PPO)	01	04		1			H4937	804	0	2023	MA-only Employer Group Plan		1	0	2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	805	0	1	04	01	H4937_805_0	2	1						05/20/2022	2023.01	05/20/2022 11:04:14 AM Pacific Daylight Time					06/03/2022 02:16:51 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	CCPOA Medical Plan Medicare (PPO)	01	04		1			H4937	805	0	2023	MAPD Employer Group Plan for CCPOA Only		1	23818	2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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									
H4943	001	0	1	01	01	H4943_001_0	7	1					1	08/04/2022	2023.01	08/04/2022 10:52:35 AM Central Daylight Time	08/04/2022 10:49:53 AM Central Daylight Time	08/04/2022 10:50:04 AM Central Daylight Time			08/04/2022 10:53:10 AM Central Daylight Time	Scott & White Care Plans	Baylor Scott & White Health Plan	https://www.bswhealthplan.com	Covenant Health Advantage Rx (HMO)	01	01		1			H4943	001	0	2023	West Texas		2		2			2									BSWHealthPlan.com	BSWHealthPlan.com	https://www.bswhealthplan.com/Pages/Provider.aspx	(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			
H4943	002	0	1	01	01	H4943_002_0	6	1				0	0	07/12/2022	2023.01	07/12/2022 08:40:14 AM Central Daylight Time	06/06/2022 10:10:04 PM Central Daylight Time				07/12/2022 08:52:16 AM Central Daylight Time	Scott & White Care Plans	Baylor Scott & White Health Plan	https://www.bswhealthplan.com	Covenant Health Advantage (HMO)	01	01		1			H4943	002	0	2023	West Texas		2		2			2									BSWHealthPlan.com	BSWHealthPlan.com	https://www.bswhealthplan.com/Pages/Provider.aspx	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4961	001	0	1	04	01	H4961_001_0	6	1						08/05/2022	2023.01	08/05/2022 12:10:55 PM Pacific Daylight Time	08/05/2022 09:38:26 AM Pacific Daylight Time	08/02/2022 02:54:36 PM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health My Choice (PPO)	01	04		1			H4961	001	0	2023	Sacramento, Placer & Yolo , SJ, ST, Santa Cruz		2		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	6	1						08/05/2022	2023.01	08/05/2022 11:45:19 AM Pacific Daylight Time	08/05/2022 09:38:26 AM Pacific Daylight Time	08/02/2022 02:55:32 PM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health My Choice (PPO)	01	04		1			H4961	003	0	2023	Sonoma, San Mateo Counties		2		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	6	1						08/05/2022	2023.01	08/05/2022 01:01:22 PM Pacific Daylight Time	08/05/2022 09:38:16 AM Pacific Daylight Time	08/02/2022 03:00:32 PM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Balance (PPO)	01	04		1			H4961	006	0	2023	Santa Clara, San Joaquin and Stanislaus		2		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	6	1						08/05/2022	2023.01	08/05/2022 12:25:40 PM Pacific Daylight Time	08/05/2022 09:38:26 AM Pacific Daylight Time	08/02/2022 03:01:40 PM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health AVA (PPO)	01	04		1			H4961	007	0	2023	South and Central California		2		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	6	1						08/05/2022	2023.01	08/05/2022 12:13:55 PM Pacific Daylight Time	08/05/2022 09:38:26 AM Pacific Daylight Time	08/02/2022 03:02:44 PM Pacific Daylight Time			08/05/2022 01:42:46 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health PPO powered by Hoag (PPO)	01	04		1			H4961	008	0	2023	Orange		2		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	3	1						07/09/2022	2023.01	07/09/2022 09:57:05 AM Pacific Daylight Time					07/11/2022 11:42:58 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	801	0	2023	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	3	1						07/09/2022	2023.01	07/09/2022 09:57:52 AM Pacific Daylight Time					07/11/2022 11:42:58 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	802	0	2023	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	3	1				0	0	07/09/2022	2023.01	07/09/2022 09:58:45 AM Pacific Daylight Time					07/11/2022 11:42:58 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	803	0	2023	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	3	1				0	0	07/09/2022	2023.01	07/09/2022 09:58:55 AM Pacific Daylight Time					07/11/2022 11:42:58 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	804	0	2023	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	3	1						07/09/2022	2023.01	07/09/2022 09:59:08 AM Pacific Daylight Time					07/11/2022 11:42:58 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options Complete (PPO)	01	04		1			H4961	805	0	2023	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	3	1						07/09/2022	2023.01	07/09/2022 09:59:25 AM Pacific Daylight Time					07/11/2022 11:42:58 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options Complete (PPO)	01	04		1			H4961	806	0	2023	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	5	1			2			08/02/2022	2023.01	08/02/2022 01:53:56 PM Eastern Daylight Time	08/02/2022 03:31:16 PM Eastern Daylight Time	07/31/2022 11:06:44 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1			2			08/02/2022	2023.01	08/02/2022 01:54:07 PM Eastern Daylight Time	08/02/2022 03:32:13 PM Eastern Daylight Time	07/31/2022 11:07:08 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1			2			08/02/2022	2023.01	08/02/2022 01:54:20 PM Eastern Daylight Time	08/02/2022 03:33:09 PM Eastern Daylight Time	07/31/2022 11:07:34 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1			2			08/02/2022	2023.01	08/02/2022 01:54:33 PM Eastern Daylight Time	08/02/2022 03:34:04 PM Eastern Daylight Time	07/31/2022 11:07:58 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	6	1			2			08/02/2022	2023.01	08/02/2022 01:54:47 PM Eastern Daylight Time	08/02/2022 03:35:00 PM Eastern Daylight Time	07/31/2022 11:08:22 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1			2			08/02/2022	2023.01	08/02/2022 01:56:06 PM Eastern Daylight Time	08/02/2022 03:35:57 PM Eastern Daylight Time	07/31/2022 11:08:48 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1			2			08/02/2022	2023.01	08/02/2022 01:55:37 PM Eastern Daylight Time	08/02/2022 03:36:56 PM Eastern Daylight Time	07/31/2022 11:09:12 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	7	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 01:56:18 PM Eastern Daylight Time	08/02/2022 03:37:53 PM Eastern Daylight Time	07/31/2022 11:09:36 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	Northern California		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	5	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 01:56:33 PM Eastern Daylight Time	08/02/2022 03:38:51 PM Eastern Daylight Time	07/31/2022 11:10:02 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1			2			08/02/2022	2023.01	08/02/2022 01:56:47 PM Eastern Daylight Time	08/02/2022 03:39:49 PM Eastern Daylight Time	07/31/2022 11:10:28 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1			2			08/02/2022	2023.01	08/02/2022 01:57:03 PM Eastern Daylight Time	08/02/2022 03:40:49 PM Eastern Daylight Time	07/31/2022 11:10:54 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	5	1			2			08/02/2022	2023.01	08/02/2022 01:57:17 PM Eastern Daylight Time	08/02/2022 03:41:45 PM Eastern Daylight Time	07/31/2022 11:11:20 PM Eastern Daylight Time			08/04/2022 05:26:51 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	2023	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	3	1			2	0	0	05/31/2022	2023.01	05/31/2022 02:50:36 PM Eastern Daylight Time	06/01/2022 02:23:45 PM Eastern Daylight Time				06/02/2022 01:59:02 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	2023	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	016	0	1	01	01	H4982_016_0	5	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 01:57:46 PM Eastern Daylight Time	08/02/2022 03:43:42 PM Eastern Daylight Time	07/31/2022 11:11:46 PM Eastern Daylight Time			08/04/2022 05:26:51 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	016	0	2023	San Diego County		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	801	0	1	01	01	H4982_801_0	1	1				0	0	05/27/2022	2023.01	05/27/2022 04:10:25 PM Eastern Daylight Time					06/02/2022 03:26:31 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	2023	California		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H4982	802	0	1	01	01	H4982_802_0	1	1						05/30/2022	2023.01	05/30/2022 05:56:37 PM Eastern Daylight Time					06/02/2022 03:26:31 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	2023	California		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H4999	001	0	1	20	08	H4999_001_0	2	1						06/02/2022	2023.01	06/02/2022 02:39:10 PM Eastern Daylight Time		06/02/2022 02:27:36 PM Eastern Daylight Time			06/02/2022 02:40:55 PM Eastern Daylight Time	LIFE Northwestern Pennsylvania, LLC	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	08	20		1			H4999	001	0	2023	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	2	1						06/02/2022	2023.01	06/02/2022 02:39:46 PM Eastern Daylight Time		06/02/2022 02:27:36 PM Eastern Daylight Time			06/02/2022 02:40:55 PM Eastern Daylight Time	LIFE Northwestern Pennsylvania, LLC	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	08	20		1			H4999	002	0	2023	Counties: Erie, War, Craw, Mer, Ven, McK, For, Cla		2		2			2									www.lifenwpa.org	www.lifenwpa.org										(844)456-5433		(814)456-5433		(844)456-5433		(814)456-5433										(814)456-5433		(814)456-5433		(814)456-5433		(814)456-5433																
H5007	001	0	1	20	08	H5007_001_0	1	1						05/26/2022	2023.01	05/26/2022 01:43:17 PM Pacific Daylight Time		05/26/2022 01:33:00 PM Pacific Daylight Time			05/26/2022 01:47:16 PM Pacific Daylight Time	PROVIDENCE HEALTH SYSTEM	Providence Health System	washington.providence.org/senior-care/elderplace	Providence ElderPlace - Seattle (PACE)	08	20		1			H5007	001	0	2023	Seattle - King County Washington		2		2			2									www.providence.org/longtermcare/elderplace	www.providence.org/longtermcare/elderplace										(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325										(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325																
H5007	002	0	1	20	08	H5007_002_0	1	1						05/26/2022	2023.01	05/26/2022 01:44:35 PM Pacific Daylight Time		05/26/2022 01:33:00 PM Pacific Daylight Time			05/26/2022 01:47:16 PM Pacific Daylight Time	PROVIDENCE HEALTH SYSTEM	Providence Health System	washington.providence.org/senior-care/elderplace	Providence ElderPlace - Seattle (PACE)	08	20		1			H5007	002	0	2023	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	002	0	1	02	01	H5008_002_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 01:29:56 PM Central Daylight Time	08/03/2022 10:59:26 AM Central Daylight Time	07/31/2022 02:55:36 AM Central Daylight Time			08/04/2022 03:47:24 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			H5008	002	0	2023	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	02	01	H5008_010_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 02:55:36 PM Central Daylight Time	08/03/2022 11:00:03 AM Central Daylight Time	07/31/2022 02:56:01 AM Central Daylight Time			08/04/2022 04:14:08 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			H5008	010	0	2023	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	02	01	H5008_011_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:39:10 AM Central Daylight Time	08/03/2022 11:00:40 AM Central Daylight Time	07/31/2022 02:56:26 AM Central Daylight Time			08/04/2022 04:14:08 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			H5008	011	0	2023	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	02	01	H5008_015_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 01:30:06 PM Central Daylight Time	08/03/2022 11:01:18 AM Central Daylight Time	07/31/2022 02:56:51 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H5008	015	0	2023	Select Counties in West 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	016	0	1	02	01	H5008_016_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:40:04 AM Central Daylight Time	08/03/2022 11:01:55 AM Central Daylight Time	07/31/2022 02:57:16 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H5008	016	0	2023	Select Counties in Mississippi		2		2			1	3		2					2	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			
H5009	001	0	1	04	01	H5009_001_0	6	1				0	0	07/06/2022	2023.01	07/06/2022 01:58:53 PM Pacific Daylight Time	06/01/2022 05:26:28 PM Pacific Daylight Time				07/11/2022 09:05:44 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence Valiance (PPO)	01	04		1			H5009	001	0	2023	Select Counties in Washington		2		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)-		(800)735-2900		(711)-										2					2						2			
H5009	002	0	1	04	01	H5009_002_0	9	1					1	07/06/2022	2023.01	07/06/2022 02:24:17 PM Pacific Daylight Time	08/04/2022 02:37:11 PM Pacific Daylight Time	08/01/2022 01:57:07 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H5009	002	0	2023	Select Counties in Washington		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H5009	008	0	1	04	01	H5009_008_0	8	1					1	08/04/2022	2023.01	08/04/2022 02:34:19 PM Eastern Daylight Time	08/04/2022 02:37:48 PM Pacific Daylight Time	08/01/2022 01:59:08 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H5009	008	0	2023	Select Counties in Washington		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H5009	009	0	1	04	01	H5009_009_0	9	1					1	08/04/2022	2023.01	08/04/2022 02:40:09 PM Eastern Daylight Time	08/04/2022 02:38:26 PM Pacific Daylight Time	08/01/2022 02:00:23 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	01	04		1			H5009	009	0	2023	Select Counties in Washington		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H5009	010	0	1	04	01	H5009_010_0	8	1					1	08/05/2022	2023.01	08/05/2022 12:48:19 PM Pacific Daylight Time	08/05/2022 01:53:37 PM Pacific Daylight Time	08/01/2022 02:01:32 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Core (PPO)	01	04		1			H5009	010	0	2023	King County and Snohomish County		2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H5009	801	0	1	04	01	H5009_801_0	1	1				0	0	05/06/2022	2023.01	05/06/2022 09:51:38 AM Pacific Daylight Time					05/17/2022 02:26:52 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H5009	801	0	2023	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	1	1						05/06/2022	2023.01	05/06/2022 09:51:45 AM Pacific Daylight Time					05/17/2022 02:26:52 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H5009	802	0	2023	Nationwide except territories		1	11952	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	1	1						05/06/2022	2023.01	05/06/2022 09:51:52 AM Pacific Daylight Time					05/17/2022 02:26:52 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	01	04		1			H5009	803	0	2023	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;9c;10a;11a;11b;11c;15;	2		1									
H5009	804	0	1	04	01	H5009_804_0	1	1						05/06/2022	2023.01	05/06/2022 09:51:58 AM Pacific Daylight Time					05/17/2022 02:26:52 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	01	04		1			H5009	804	0	2023	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	6	1				0	0	07/06/2022	2023.01	07/06/2022 02:39:45 PM Pacific Daylight Time	06/01/2022 05:29:28 PM Pacific Daylight Time				07/11/2022 09:05:44 AM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Esteem (PPO)	01	04		1			H5010	001	0	2023	Spokane and Chelan Counties		2		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)-		(800)735-2900		(711)-										2					2						2			
H5010	008	1	1	04	01	H5010_008_1	9	1					1	08/04/2022	2023.01	08/04/2022 03:08:31 PM Eastern Daylight Time	08/04/2022 02:39:40 PM Pacific Daylight Time	08/01/2022 02:02:44 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Primary (PPO)	01	04		1			H5010	008	1	2023	Spokane and Chelan Counties	Spokane County	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H5010	008	2	1	04	01	H5010_008_2	9	1					1	08/04/2022	2023.01	08/04/2022 03:16:50 PM Eastern Daylight Time	08/04/2022 02:40:17 PM Pacific Daylight Time	08/01/2022 02:03:55 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Primary (PPO)	01	04		1			H5010	008	2	2023	Spokane and Chelan Counties	Chelan County	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H5010	009	1	1	04	01	H5010_009_1	8	1					1	08/04/2022	2023.01	08/04/2022 03:21:45 PM Eastern Daylight Time	08/04/2022 02:40:57 PM Pacific Daylight Time	08/01/2022 02:05:06 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Classic (PPO)	01	04		1			H5010	009	1	2023	Spokane and Chelan Counties	Spokane County	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H5010	009	2	1	04	01	H5010_009_2	8	1					1	08/04/2022	2023.01	08/04/2022 03:26:24 PM Eastern Daylight Time	08/04/2022 04:00:02 PM Pacific Daylight Time	08/01/2022 02:06:53 PM Pacific Daylight Time			08/05/2022 03:08:36 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Classic (PPO)	01	04		1			H5010	009	2	2023	Spokane and Chelan Counties	Chelan County	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2						2			
H5015	001	0	1	01	01	H5015_001_0	5	1		1				07/15/2022	2023.01	07/15/2022 12:06:42 PM Eastern Daylight Time	08/04/2022 09:13:40 PM Eastern Daylight Time	08/04/2022 09:13:40 PM Eastern Daylight Time			08/04/2022 09:15:08 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	2023	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		(866)213-1594		(866)213-1594		(866)213-1594		(866)213-1594		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5037	001	0	1	20	08	H5037_001_0	1	1						06/01/2022	2023.01	06/01/2022 09:35:43 AM Eastern Daylight Time		06/01/2022 09:29:46 AM Eastern Daylight Time			06/01/2022 09:41:42 AM 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	2023	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						06/01/2022	2023.01	06/01/2022 09:36:14 AM Eastern Daylight Time		06/01/2022 09:29:46 AM Eastern Daylight Time			06/01/2022 09:41:42 AM 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	2023	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	14	1			1		1	08/05/2022	2023.01	08/05/2022 10:53:40 AM Eastern Daylight Time	08/05/2022 01:43:57 PM Eastern Daylight Time	08/05/2022 01:43:57 PM Eastern Daylight Time			08/05/2022 01:47:06 PM 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	2023	Greater Capital Region of New York State		2		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	11	8a1;8a2;	18a1;
H5042	011	0	1	04	01	H5042_011_0	13	1			1		1	07/12/2022	2023.01	07/12/2022 11:55:47 AM Eastern Daylight Time	08/05/2022 01:43:57 PM Eastern Daylight Time	08/05/2022 01:43:58 PM Eastern Daylight Time			08/05/2022 01:47:06 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	2023	Greater Capital Region of New York State		2		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	11	8a1;8a2;	18a1;
H5042	012	0	1	04	01	H5042_012_0	12	1			1	0	0	07/12/2022	2023.01	07/12/2022 10:58:43 AM Eastern Daylight Time	06/06/2022 11:52:09 AM Eastern Daylight Time				07/12/2022 11:04:23 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Flex (PPO)	01	04		1			H5042	012	0	2023	Greater Capital Region of New York State		2		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	11	8a1;8a2;	18a1;
H5042	801	0	1	04	01	H5042_801_0	7	1						05/11/2022	2023.01	05/11/2022 11:16:17 AM Eastern Daylight Time					06/06/2022 11:57:34 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Advantage		CDPHP Group Medicare Rx (PPO)	01	04		1			H5042	801	0	2023	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	7	1						05/11/2022	2023.01	05/11/2022 11:16:37 AM Eastern Daylight Time					06/06/2022 11:57:34 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	2023	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	7	1				0	0	05/11/2022	2023.01	05/11/2022 11:17:01 AM Eastern Daylight Time					06/06/2022 11:57:34 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	2023	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	9	1				0	0	06/06/2022	2023.01	06/06/2022 08:42:11 AM Pacific Daylight Time	06/06/2022 12:45:14 PM Pacific Daylight Time				06/06/2022 01:49:48 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	2023	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	12	1						08/02/2022	2023.01	08/02/2022 04:00:01 PM Pacific Daylight Time	08/03/2022 02:50:57 PM Pacific Daylight Time	08/03/2022 11:47:06 AM Pacific Daylight Time			08/04/2022 03:06:10 PM 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	2023	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	12	1						08/02/2022	2023.01	08/02/2022 04:04:20 PM Pacific Daylight Time	08/03/2022 02:51:19 PM Pacific Daylight Time	08/03/2022 11:47:51 AM Pacific Daylight Time			08/04/2022 03:06:10 PM 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	2023	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	12	1						08/03/2022	2023.01	08/03/2022 09:48:09 AM Pacific Daylight Time	08/03/2022 02:51:40 PM Pacific Daylight Time	08/03/2022 11:48:36 AM Pacific Daylight Time			08/04/2022 03:06:10 PM 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	2023	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	12	1						08/03/2022	2023.01	08/03/2022 01:51:49 PM Pacific Daylight Time	08/03/2022 02:52:01 PM Pacific Daylight Time	08/03/2022 11:49:20 AM Pacific Daylight Time			08/04/2022 03:06:10 PM 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	2023	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	12	1						08/02/2022	2023.01	08/02/2022 05:04:19 PM Pacific Daylight Time	08/03/2022 02:52:22 PM Pacific Daylight Time	08/03/2022 11:50:07 AM Pacific Daylight Time			08/04/2022 03:06:10 PM 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	2023	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	12	1						08/03/2022	2023.01	08/03/2022 01:51:36 PM Pacific Daylight Time	08/03/2022 02:52:43 PM Pacific Daylight Time	08/03/2022 11:50:53 AM Pacific Daylight Time			08/04/2022 03:06:10 PM 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	2023	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	12	1						08/03/2022	2023.01	08/03/2022 01:57:56 PM Pacific Daylight Time	08/03/2022 02:53:04 PM Pacific Daylight Time	08/03/2022 11:51:40 AM Pacific Daylight Time			08/04/2022 03:06:10 PM 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	2023	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	12	1						08/03/2022	2023.01	08/03/2022 01:59:42 PM Pacific Daylight Time	08/03/2022 06:41:24 PM Pacific Daylight Time	08/03/2022 11:52:27 AM Pacific Daylight Time			08/04/2022 03:06:10 PM 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	2023	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	9	1				0	0	04/28/2022	2023.01	04/28/2022 12:29:21 PM Pacific Daylight Time					06/06/2022 01:49:48 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	2023	Puget Sound Area and Counties: GY, TH, LE, SP		1	325206	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	9	1						04/28/2022	2023.01	04/28/2022 12:55:44 PM Pacific Daylight Time					06/06/2022 01:49:48 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	2023	Puget Sound Area and Counties: GY, TH, LE, SP		1	36134	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						06/01/2022	2023.01	06/01/2022 01:08:08 PM Eastern Daylight Time		06/03/2022 11:13:10 AM Eastern Daylight Time			06/03/2022 11:14:18 AM Eastern 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	2023	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	7	1						06/01/2022	2023.01	06/01/2022 01:41:05 PM Eastern Daylight Time		06/03/2022 01:59:08 PM Eastern Daylight Time			06/03/2022 03:07:57 PM Eastern 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	2023	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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 08:33:33 AM Pacific Daylight Time	08/03/2022 08:20:31 PM Eastern Daylight Time	07/30/2022 09:24:01 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Align 001 (HMO D-SNP)	01	01		1			H5087	001	0	2023	Select counties in CA		2		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	005	0	1	01	01	H5087_005_0	4	1						08/01/2022	2023.01	08/01/2022 12:50:37 PM Eastern Daylight Time	08/03/2022 08:21:40 PM Eastern Daylight Time	07/30/2022 09:24:32 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Best (HMO)	01	01		1			H5087	005	0	2023	Select counties in CA		2		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						08/01/2022	2023.01	08/01/2022 12:53:02 PM Eastern Daylight Time	08/03/2022 08:22:48 PM Eastern Daylight Time	07/30/2022 09:25:04 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Best (HMO)	01	01		1			H5087	016	0	2023	Select counties in CA		2		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						08/01/2022	2023.01	08/01/2022 12:55:08 PM Eastern Daylight Time	08/03/2022 08:28:59 PM Eastern Daylight Time	07/30/2022 09:25:36 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H5087	024	0	2023	Select counties in CA		2		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	5	1						08/01/2022	2023.01	08/01/2022 12:56:51 PM Eastern Daylight Time	08/03/2022 08:30:32 PM Eastern Daylight Time	07/30/2022 09:26:07 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H5087	026	0	2023	Select counties in CA		2		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	7	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 08:38:27 AM Pacific Daylight Time	08/03/2022 08:31:40 PM Eastern Daylight Time	07/30/2022 09:26:40 AM Eastern Daylight Time			08/04/2022 05:10:27 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	2023	Select counties in CA		2		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	4	1			2		1	08/01/2022	2023.01	08/01/2022 12:58:59 PM Eastern Daylight Time	08/03/2022 08:32:49 PM Eastern Daylight Time	07/30/2022 09:27:11 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Focus (HMO)	01	01		1			H5087	028	0	2023	Select counties in CA		2		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;7j;7k;16b;17a;18a;	
H5087	029	1	1	01	01	H5087_029_1	4	1						08/01/2022	2023.01	08/01/2022 01:00:53 PM Eastern Daylight Time	08/03/2022 08:33:59 PM Eastern Daylight Time	07/30/2022 09:27:42 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H5087	029	1	2023	Selected counties in California	Select counties in California	2		2			2									www.wellcare.com/our_pharmacies/default	www.wellcare.com/medicare/medication_guide	www.wellcare.com/fap_search	(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	029	2	1	01	01	H5087_029_2	4	1						08/03/2022	2023.01	08/03/2022 03:25:53 PM Eastern Daylight Time	08/03/2022 08:35:05 PM Eastern Daylight Time	07/30/2022 09:28:14 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H5087	029	2	2023	Selected counties in California	Ventura	2		2			2									www.wellcare.com/our_pharmacies/default	www.wellcare.com/medicare/medication_guide	www.wellcare.com/fap_search	(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			
H5106	013	0	1	04	01	H5106_013_0	10	1					1	07/18/2022	2023.01	07/18/2022 08:22:11 AM Eastern Daylight Time	08/02/2022 09:52:34 PM Eastern Daylight Time	08/05/2022 12:23:28 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Standard (PPO)	01	04		1			H5106	013	0	2023	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	9	1					1	08/04/2022	2023.01	08/04/2022 11:57:09 AM Eastern Daylight Time	08/03/2022 10:49:10 AM Eastern Daylight Time	08/05/2022 12:24:08 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Distinct (PPO)	01	04		1			H5106	029	1	2023	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	9	1					1	08/04/2022	2023.01	08/04/2022 11:57:25 AM Eastern Daylight Time	08/03/2022 10:50:13 AM Eastern Daylight Time	08/05/2022 12:24:47 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Distinct (PPO)	01	04		1			H5106	029	2	2023	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	9	1					0	07/18/2022	2023.01	07/18/2022 08:21:35 AM Eastern Daylight Time	08/02/2022 09:55:15 PM Eastern Daylight Time	08/05/2022 12:25:27 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Signature (PPO)	01	04		1			H5106	030	1	2023	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	9	1					0	07/18/2022	2023.01	07/18/2022 08:21:21 AM Eastern Daylight Time	08/02/2022 09:56:20 PM Eastern Daylight Time	08/05/2022 12:26:07 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Signature (PPO)	01	04		1			H5106	030	2	2023	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	031	1	1	04	01	H5106_031_1	9	1					0	07/18/2022	2023.01	07/18/2022 08:21:06 AM Eastern Daylight Time	08/02/2022 09:57:13 PM Eastern Daylight Time	08/05/2022 12:26:47 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Merit (PPO)	01	04		1			H5106	031	1	2023	WV 2 Region	WV North	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	031	2	1	04	01	H5106_031_2	9	1					0	07/18/2022	2023.01	07/18/2022 08:20:54 AM Eastern Daylight Time	08/02/2022 09:58:11 PM Eastern Daylight Time	08/05/2022 12:27:27 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Merit (PPO)	01	04		1			H5106	031	2	2023	WV 2 Region	WV South	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	032	1	1	04	01	H5106_032_1	9	1					1	08/04/2022	2023.01	08/04/2022 11:58:31 AM Eastern Daylight Time	08/03/2022 10:50:51 AM Eastern Daylight Time	08/05/2022 12:28:06 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Prestige (PPO)	01	04		1			H5106	032	1	2023	WV 2 Region	WV North	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	032	2	1	04	01	H5106_032_2	9	1					1	08/04/2022	2023.01	08/04/2022 11:58:54 AM Eastern Daylight Time	08/03/2022 10:51:27 AM Eastern Daylight Time	08/05/2022 12:28:46 PM Eastern Daylight Time			08/05/2022 01:34:14 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Prestige (PPO)	01	04		1			H5106	032	2	2023	WV 2 Region	WV South	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	033	1	1	04	01	H5106_033_1	6	1				0	0	07/18/2022	2023.01	07/18/2022 08:20:15 AM Eastern Daylight Time	07/21/2022 09:51:51 PM Eastern Daylight Time				07/26/2022 01:26:18 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Valor (PPO)	01	04		1			H5106	033	1	2023	WV 2 Region	WV North	2		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)-										2					2						2			
H5106	033	2	1	04	01	H5106_033_2	6	1				0	0	07/18/2022	2023.01	07/18/2022 08:19:52 AM Eastern Daylight Time	07/21/2022 09:52:22 PM Eastern Daylight Time				07/26/2022 01:26:18 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Valor (PPO)	01	04		1			H5106	033	2	2023	WV 2 Region	WV South	2		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)-										2					2						2			
H5106	806	0	1	04	01	H5106_806_0	3	1						06/03/2022	2023.01	06/03/2022 06:41:21 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	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;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	3	1				0	0	06/03/2022	2023.01	06/03/2022 06:42:06 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	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;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	3	1						06/03/2022	2023.01	06/03/2022 06:41:55 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	ALL WV COUNTIES		1	10341	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;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	810	0	1	04	01	H5106_810_0	3	1						06/03/2022	2023.01	06/03/2022 06:41:43 PM Eastern Daylight Time					06/03/2022 06:57:37 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD WV ASO CALENDAR (PPO)	01	04		1			H5106	810	0	2023	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;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	4	1						08/03/2022	2023.01	08/03/2022 02:26:25 PM Eastern Daylight Time	08/03/2022 09:36:36 PM Eastern Daylight Time	07/30/2022 09:28:46 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in LA		2		2			2									www.wellcare.com/allwellLA	www.wellcare.com/allwellLA	www.wellcare.com/allwellLA	(855)766-1572		(855)766-1572		(844)917-0175		(844)917-0175		(855)766-1572		(855)766-1572		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	004	0	1	01	01	H5117_004_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 08:22:30 AM Pacific Daylight Time	08/03/2022 09:38:24 PM Eastern Daylight Time	07/30/2022 09:29:18 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in LA		2		2			1	3		1					1	www.wellcare.com/allwellLA	www.wellcare.com/allwellLA	www.wellcare.com/allwellLA	(833)541-0767		(833)541-0767		(844)917-0175		(844)917-0175		(833)541-0767		(833)541-0767		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	801	0	1	01	01	H5117_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:16:00 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Wellcare by Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	01	01		1			H5117	801	0	2023	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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:16:06 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Wellcare by Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	01	01		1			H5117	802	0	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:16:10 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Wellcare by Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	01	01		1			H5117	803	0	2023	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						06/03/2022	2023.01	06/03/2022 03:09:34 PM US Eastern Daylight Time		06/03/2022 09:21:34 AM US Eastern Daylight Time			06/03/2022 03:12:03 PM US Eastern Daylight Time	FRANCISCAN ACO, INC.	Franciscan  Senior Health & Wellness	FranciscanHealth.org	Franciscan Senior Health and Wellness (PACE)	08	20		1			H5124	001	0	2023	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						06/03/2022	2023.01	06/03/2022 03:10:00 PM US Eastern Daylight Time		06/03/2022 09:21:34 AM US Eastern Daylight Time			06/03/2022 03:12:03 PM US Eastern Daylight Time	FRANCISCAN ACO, INC.	Franciscan  Senior Health & Wellness	FranciscanHealth.org	Franciscan Senior Health and Wellness (PACE)	08	20		1			H5124	002	0	2023	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																
H5140	001	0	1	04	01	H5140_001_0	16	1						09/20/2022	2023.01	09/20/2022 11:31:21 AM US Mountain Standard Time	08/03/2022 09:30:37 AM US Mountain Standard Time	08/01/2022 03:46:28 PM US Mountain Standard Time			09/20/2022 02:57:02 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	2023	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	13	1						09/16/2022	2023.01	09/16/2022 11:49:55 AM US Mountain Standard Time	08/03/2022 09:55:34 AM US Mountain Standard Time	08/01/2022 03:46:36 PM US Mountain Standard Time			09/20/2022 02:57:02 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	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 05:52:39 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:26 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	001	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 05:56:28 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:29 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	004	0	2023	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	6	1					0	08/04/2022	2023.01	08/04/2022 08:48:17 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:31 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	007	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 06:00:11 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:27 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	025	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 06:01:06 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:33 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	026	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 06:02:06 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:35 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	032	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 06:02:46 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:36 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	033	0	2023	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	036	0	1	04	01	H5141_036_0	7	1					1	08/05/2022	2023.01	08/05/2022 06:03:49 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:38 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	036	0	2023	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	8	1					1	08/05/2022	2023.01	08/05/2022 06:04:40 PM Eastern Daylight Time	08/09/2022 11:50:56 AM Eastern Daylight Time	08/09/2022 11:50:56 AM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	037	0	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 08:02:13 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:40 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	038	0	2023	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	042	0	1	04	01	H5141_042_0	6	1						08/04/2022	2023.01	08/04/2022 08:50:08 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:42 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	042	0	2023	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	5	1					0	08/05/2022	2023.01	08/05/2022 06:06:13 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/05/2022 08:14:13 PM Eastern Daylight Time			08/05/2022 08:54:12 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	045	0	2023	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	050	0	1	04	01	H5141_050_0	7	1					1	08/05/2022	2023.01	08/05/2022 06:09:51 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:43 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	050	0	2023	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	7	1						08/05/2022	2023.01	08/05/2022 06:10:51 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:45 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	051	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 06:11:31 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:47 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	052	0	2023	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	053	0	1	04	01	H5141_053_0	8	1						08/05/2022	2023.01	08/05/2022 06:12:23 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:49 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	053	0	2023	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	8	1					1	08/04/2022	2023.01	08/04/2022 08:05:20 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/05/2022 08:14:13 PM Eastern Daylight Time			08/05/2022 08:54:12 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Premier (PPO)	01	04		1			H5141	054	0	2023	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	7	1						08/04/2022	2023.01	08/04/2022 07:05:22 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:50 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Premier Value (PPO)	01	04		1			H5141	055	0	2023	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	056	0	1	04	01	H5141_056_0	4	1				0	0	07/13/2022	2023.01	07/13/2022 09:35:15 AM Pacific Daylight Time	06/06/2022 04:47:37 PM Eastern Daylight Time				07/15/2022 04:48:06 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Valor (PPO)	01	04		1			H5141	056	0	2023	Select Georgia 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5141	057	0	1	04	01	H5141_057_0	4	1				0	0	07/13/2022	2023.01	07/13/2022 09:36:34 AM Pacific Daylight Time	06/06/2022 04:47:37 PM Eastern Daylight Time				07/15/2022 04:48:06 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Valor (PPO)	01	04		1			H5141	057	0	2023	Select South Carolina 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5141	058	0	1	04	01	H5141_058_0	9	1					0	08/05/2022	2023.01	08/05/2022 09:55:23 AM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/05/2022 08:14:13 PM Eastern Daylight Time			08/05/2022 08:54:12 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	058	0	2023	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	059	0	1	04	01	H5141_059_0	7	1					0	08/04/2022	2023.01	08/04/2022 07:37:44 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:54 PM Eastern Daylight Time			08/11/2022 06:16:29 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	059	0	2023	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	801	0	1	04	01	H5141_801_0	2	1						05/26/2022	2023.01	05/26/2022 08:34:23 AM Eastern Daylight Time					06/06/2022 05:46:59 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Employer Group Plan (PPO)	01	04		1			H5141	801	0	2023	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						06/01/2022	2023.01	06/01/2022 11:30:48 AM Mountain Daylight Time		05/24/2022 10:41:26 PM Mountain Daylight Time			06/01/2022 11:41:22 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	001	0	2023	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						06/01/2022	2023.01	06/01/2022 11:09:18 AM Mountain Daylight Time		05/24/2022 10:43:50 PM Mountain Daylight Time			06/01/2022 11:41:22 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	002	0	2023	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															
H5178	001	0	1	01	01	H5178_001_0	3	1			2			08/01/2022	2023.01	08/01/2022 02:56:44 PM Eastern Daylight Time	08/03/2022 05:32:24 PM Eastern Daylight Time	07/30/2022 06:48:32 AM Eastern Daylight Time			08/04/2022 03:56:59 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	2023	Greenville County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	801	0	1	01	01	H5190_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:16:47 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellFL	Wellcare Group Medicare Advantage (HMO)	01	01		1			H5190	801	0	2023	Select Counties in Florida		1	100	2			2									www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5190	802	0	1	01	01	H5190_802_0	1	1						05/10/2022	2023.01	05/10/2022 11:16:51 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellFL	Wellcare Group Medicare Advantage (HMO)	01	01		1			H5190	802	0	2023	Select Counties in Florida		1	100	2			2									www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5190	803	0	1	01	01	H5190_803_0	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:16:55 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellFL	Wellcare Group Medicare Advantage (HMO)	01	01		1			H5190	803	0	2023	Select Counties in Florida		1	100	2			2									www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5199	008	0	1	04	01	H5199_008_0	5	1			2			08/02/2022	2023.01	08/02/2022 11:34:59 AM Eastern Daylight Time	08/03/2022 08:59:33 PM Eastern Daylight Time	07/30/2022 09:29:49 AM Eastern Daylight Time			08/04/2022 05:35:09 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	2023	Select counties in FL		2		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			2			08/02/2022	2023.01	08/02/2022 11:36:35 AM Eastern Daylight Time	08/03/2022 09:00:45 PM Eastern Daylight Time	07/30/2022 09:30:22 AM Eastern Daylight Time			08/04/2022 05:35:09 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	2023	Select counties in FL		2		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			2			08/02/2022	2023.01	08/02/2022 11:38:12 AM Eastern Daylight Time	08/03/2022 09:01:56 PM Eastern Daylight Time	07/30/2022 09:30:53 AM Eastern Daylight Time			08/04/2022 05:35:09 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	2023	Select counties in FL		2		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			2			08/02/2022	2023.01	08/02/2022 11:39:56 AM Eastern Daylight Time	08/03/2022 09:03:08 PM Eastern Daylight Time	07/30/2022 09:31:25 AM Eastern Daylight Time			08/04/2022 05:35:09 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	2023	Select counties in FL		2		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			2			08/02/2022	2023.01	08/02/2022 11:42:26 AM Eastern Daylight Time	08/03/2022 09:04:20 PM Eastern Daylight Time	07/30/2022 09:31:56 AM Eastern Daylight Time			08/04/2022 05:35:09 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	2023	Select counties in FL		2		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	1		0	07/05/2022	2023.01	07/05/2022 03:23:12 PM Eastern Daylight Time	08/03/2022 09:05:34 PM Eastern Daylight Time	07/30/2022 09:32:29 AM Eastern Daylight Time			08/04/2022 05:35:09 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	2023	Select counties in FL		2		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	7	1	2	1			0	05/26/2022	2023.01	05/26/2022 11:56:58 AM Central Daylight Time	08/02/2022 03:27:47 PM Central Daylight Time	08/02/2022 03:27:48 PM Central Daylight Time			08/02/2022 03:40:00 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	2023	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	07/15/2022	2023.01	07/15/2022 03:06:57 PM Central Daylight Time	08/02/2022 03:27:17 PM Central Daylight Time	08/02/2022 03:27:17 PM Central Daylight Time			08/02/2022 03:40:00 PM 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	2023	Southern, Central 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		2					2					2	2			
H5211	001	0	1	02	01	H5211_001_0	4	1				0	0	07/14/2022	2023.01	07/14/2022 03:54:59 PM Central Daylight Time	07/12/2022 12:11:04 PM Central Daylight Time				07/15/2022 01:31:04 PM 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	2023	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	4	1					1	06/28/2022	2023.01	06/28/2022 02:16:11 PM Central Daylight Time	08/02/2022 04:35:28 PM Central Daylight Time	08/02/2022 04:20:33 PM Central Daylight Time			08/05/2022 09:52:18 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	2023	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	3	1				0	0	06/28/2022	2023.01	06/28/2022 02:17:00 PM Central Daylight Time	05/31/2022 04:08:55 PM Central Daylight Time				07/11/2022 10:04:40 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	2023	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	4	1					1	06/28/2022	2023.01	06/28/2022 02:17:23 PM Central Daylight Time	08/02/2022 04:44:26 PM Central Daylight Time	08/02/2022 04:27:50 PM Central Daylight Time			08/05/2022 09:52:18 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	2023	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	6	1	2	1			0	06/28/2022	2023.01	06/28/2022 02:17:51 PM Central Daylight Time	08/02/2022 04:59:42 PM Central Daylight Time	08/02/2022 04:50:38 PM Central Daylight Time			08/05/2022 09:52:18 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	2023	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	4	1					1	08/02/2022	2023.01	08/02/2022 02:38:21 PM Central Daylight Time	08/02/2022 04:56:21 PM Central Daylight Time	08/02/2022 04:42:40 PM Central Daylight Time			08/05/2022 09:52:18 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	2023	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	013	0	1	02	01	H5211_013_0	4	1					1	06/28/2022	2023.01	06/28/2022 02:18:50 PM Central Daylight Time	08/02/2022 05:16:36 PM Central Daylight Time	08/02/2022 05:02:51 PM Central Daylight Time			08/05/2022 09:52:18 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	2023	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						04/12/2022	2023.01	04/12/2022 03:45:18 PM Central Daylight Time		05/26/2022 02:04:55 PM Central Daylight Time			05/26/2022 02:07:41 PM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.communitycareinc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	001	0	2023	Milwaukee, Waukesha, Racine, Kenosha Counties		2	5935	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						04/12/2022	2023.01	04/12/2022 03:46:21 PM Central Daylight Time		05/26/2022 02:04:55 PM Central Daylight Time			05/26/2022 02:07:41 PM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.communitycareinc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	002	0	2023	Milwaukee, Waukesha, Racine, Kenosha Counties		2	36	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						06/02/2022	2023.01	06/02/2022 10:04:38 AM Mountain Daylight Time		05/27/2022 03:44:58 PM Mountain Daylight Time			06/02/2022 10:05:28 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	2023	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						06/02/2022	2023.01	06/02/2022 10:04:48 AM Mountain Daylight Time		05/27/2022 03:51:54 PM Mountain Daylight Time			06/02/2022 10:05:28 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	2023	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	07/01/2022	2023.01	07/01/2022 02:35:53 PM Eastern Daylight Time	06/06/2022 03:56:24 PM Eastern Daylight Time				07/01/2022 02:42:00 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPlus (PPO)	01	04		1			H5215	001	0	2023	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	8	1						08/01/2022	2023.01	08/01/2022 12:16:36 PM Central Daylight Time	08/02/2022 03:42:43 PM Eastern Daylight Time	08/03/2022 02:29:49 PM Eastern Daylight Time			08/03/2022 04:33:44 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	2023	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						07/01/2022	2023.01	07/01/2022 02:35:32 PM Eastern Daylight Time	08/02/2022 03:43:18 PM Eastern Daylight Time	08/03/2022 02:29:53 PM Eastern Daylight Time			08/03/2022 04:33:44 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	2023	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	6	1				0	0	07/01/2022	2023.01	07/01/2022 02:35:20 PM Eastern Daylight Time	06/06/2022 10:21:53 AM Eastern Daylight Time				07/01/2022 02:42:00 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPremier (PPO)	01	04		1			H5215	006	0	2023	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	7	1	2	1			0	08/01/2022	2023.01	08/01/2022 12:21:15 PM Central Daylight Time	08/02/2022 10:33:35 AM Eastern Daylight Time	08/03/2022 02:29:58 PM Eastern Daylight Time			08/03/2022 04:33:44 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	2023	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	7	1						08/02/2022	2023.01	08/02/2022 10:49:01 AM Central Daylight Time	08/02/2022 10:36:12 AM Eastern Daylight Time	08/03/2022 02:30:02 PM Eastern Daylight Time			08/03/2022 04:33:44 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumSelect (PPO)	01	04		1			H5215	008	0	2023	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	9	1						08/04/2022	2023.01	08/04/2022 12:27:39 PM Eastern Daylight Time	08/02/2022 10:38:42 AM Eastern Daylight Time	08/03/2022 02:30:06 PM Eastern Daylight Time			08/04/2022 12:28:56 PM Eastern 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	2023	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	9	1						08/02/2022	2023.01	08/02/2022 11:08:26 AM Central Daylight Time	08/02/2022 10:41:13 AM Eastern Daylight Time	08/03/2022 02:30:11 PM Eastern Daylight Time			08/03/2022 04:33:44 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	2023	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	8	1						08/02/2022	2023.01	08/02/2022 11:08:48 AM Central Daylight Time	08/02/2022 10:43:52 AM Eastern Daylight Time	08/03/2022 02:30:15 PM Eastern Daylight Time			08/03/2022 04:33:44 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	2023	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						08/04/2022	2023.01	08/04/2022 12:28:14 PM Eastern Daylight Time	08/02/2022 10:46:22 AM Eastern Daylight Time	08/03/2022 02:30:19 PM Eastern Daylight Time			08/04/2022 12:28:56 PM Eastern 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	2023	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	013	0	1	04	01	H5215_013_0	6	1				0	0	07/01/2022	2023.01	07/01/2022 02:33:56 PM Eastern Daylight Time	06/06/2022 11:05:37 AM Eastern Daylight Time				07/01/2022 02:42:00 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network Health Armor (PPO)	01	04		1			H5215	013	0	2023	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	014	0	1	04	01	H5215_014_0	6	1				0	0	07/01/2022	2023.01	07/01/2022 02:33:46 PM Eastern Daylight Time	06/06/2022 10:26:14 AM Eastern Daylight Time				07/01/2022 02:42:00 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network Health Medicare Bravo (PPO)	01	04		1			H5215	014	0	2023	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)947-3529		(800)947-3529		(800)947-3529		(800)947-3529										2					2						2			
H5215	806	0	1	04	01	H5215_806_0	3	1						05/31/2022	2023.01	05/31/2022 04:31:03 PM Eastern Daylight Time					06/02/2022 10:18:05 PM Eastern 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	2023	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		2					2						2			
H5215	807	0	1	04	01	H5215_807_0	3	1				0	0	05/20/2022	2023.01	05/20/2022 11:27:34 AM Eastern Daylight Time					06/02/2022 10:18:05 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPremier EGP (PPO)	01	04		1			H5215	807	0	2023	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										2					2						2			
H5215	808	0	1	04	01	H5215_808_0	3	1						05/20/2022	2023.01	05/20/2022 11:11:48 AM Eastern Daylight Time					06/02/2022 10:18:05 PM Eastern 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	2023	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		2					2						2			
H5216	001	0	1	04	01	H5216_001_0	3	1			1		1	05/28/2022	2023.01	05/28/2022 06:24:37 PM Eastern Daylight Time	08/03/2022 03:52:55 PM Eastern Daylight Time	07/30/2022 06:48:56 AM Eastern Daylight Time			08/04/2022 11:04:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-001 (PPO)	01	04		1			H5216	001	0	2023	Select Counties in Eastern Wisconsin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/29/2022	2023.01	05/29/2022 02:33:19 PM Eastern Daylight Time	08/03/2022 03:42:52 PM Eastern Daylight Time	07/30/2022 06:49:22 AM Eastern Daylight Time			08/04/2022 11:04:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-006 (PPO)	01	04		1			H5216	006	0	2023	Madison area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	05/28/2022	2023.01	05/28/2022 10:32:15 AM Eastern Daylight Time	08/03/2022 04:19:40 PM Eastern Daylight Time	07/30/2022 06:49:44 AM Eastern Daylight Time			08/04/2022 12:05:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-009 (PPO)	01	04		1			H5216	009	0	2023	Select Counties in Western Michigan		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	011	0	1	04	01	H5216_011_0	4	1			1		1	05/28/2022	2023.01	05/28/2022 11:15:26 AM Eastern Daylight Time	08/03/2022 04:32:37 PM Eastern Daylight Time	07/30/2022 06:50:10 AM Eastern Daylight Time			08/04/2022 12:05:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-011 (PPO)	01	04		1			H5216	011	0	2023	Oakland, Macomb, and Wayne counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 06:43:35 PM Eastern Daylight Time	08/03/2022 03:56:30 PM Eastern Daylight Time	07/30/2022 06:50:34 AM Eastern Daylight Time			08/04/2022 11:43:15 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-013 (PPO)	01	04		1			H5216	013	0	2023	Select Counties in Illinois		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 09:33:46 AM Eastern Daylight Time	08/03/2022 03:42:46 PM Eastern Daylight Time	07/30/2022 06:50:58 AM Eastern Daylight Time			08/04/2022 10:43:49 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-014 (PPO)	01	04		1			H5216	014	0	2023	Select Counties in Iowa and Nebraska		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:25:51 PM Eastern Daylight Time	08/03/2022 04:07:45 PM Eastern Daylight Time	07/30/2022 06:51:22 AM Eastern Daylight Time			08/04/2022 02:59:41 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-017 (PPO)	01	04		1			H5216	017	0	2023	Greensboro		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	019	0	1	04	01	H5216_019_0	3	1			1		1	05/30/2022	2023.01	05/30/2022 01:40:53 PM Eastern Daylight Time	08/03/2022 04:33:36 PM Eastern Daylight Time	07/30/2022 06:51:48 AM Eastern Daylight Time			08/04/2022 04:46:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-019 (PPO)	01	04		1			H5216	019	0	2023	Central Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/29/2022	2023.01	05/29/2022 01:26:00 PM Eastern Daylight Time	08/03/2022 04:28:05 PM Eastern Daylight Time	07/30/2022 06:52:14 AM Eastern Daylight Time			08/04/2022 06:27:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-021 (PPO)	01	04		1			H5216	021	0	2023	Charleston-Huntington Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/28/2022	2023.01	05/28/2022 09:36:50 AM Eastern Daylight Time	08/03/2022 04:20:09 PM Eastern Daylight Time	07/30/2022 06:52:38 AM Eastern Daylight Time			08/04/2022 12:42:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-023 (PPO)	01	04		1			H5216	023	0	2023	Cincinnati, Dayton and Columbus Metro Areas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/13/2022	2023.01	07/13/2022 02:44:34 PM Eastern Daylight Time	08/03/2022 04:33:05 PM Eastern Daylight Time	07/30/2022 06:53:02 AM Eastern Daylight Time			08/04/2022 12:42:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-024 (PPO)	01	04		1			H5216	024	0	2023	Cleveland-Akron Metro Areas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	06/02/2022	2023.01	06/02/2022 05:54:24 PM Eastern Daylight Time	08/03/2022 04:08:42 PM Eastern Daylight Time	07/30/2022 06:53:28 AM Eastern Daylight Time			08/04/2022 04:33:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-027 (PPO)	01	04		1			H5216	027	0	2023	Fredericksburg, Northern Virginia, & Roanoke areas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	029	0	1	04	01	H5216_029_0	4	1			1		1	05/29/2022	2023.01	05/29/2022 10:20:02 AM Eastern Daylight Time	08/03/2022 04:03:26 PM Eastern Daylight Time	07/30/2022 06:53:52 AM Eastern Daylight Time			08/04/2022 04:33:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-029 (PPO)	01	04		1			H5216	029	0	2023	Delaware and Maryland		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	032	0	1	04	01	H5216_032_0	3	1			1		1	07/13/2022	2023.01	07/13/2022 03:27:10 PM Eastern Daylight Time	08/03/2022 03:44:46 PM Eastern Daylight Time	07/30/2022 06:54:18 AM Eastern Daylight Time			08/04/2022 10:43:49 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-032 (PPO)	01	04		1			H5216	032	0	2023	Select Counties in Illinois, Kansas and Missouri		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 10:47:37 AM Eastern Daylight Time	08/03/2022 03:42:12 PM Eastern Daylight Time	07/30/2022 06:54:42 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-034 (PPO)	01	04		1			H5216	034	0	2023	Select Counties in Arizona		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/06/2022	2023.01	07/06/2022 11:51:56 AM Eastern Daylight Time	08/03/2022 04:06:21 PM Eastern Daylight Time	07/30/2022 06:55:08 AM Eastern Daylight Time			08/04/2022 02:08:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-037 (PPO)	01	04		1			H5216	037	0	2023	Clark and Nye Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 09:09:01 AM Eastern Daylight Time	08/03/2022 04:14:45 PM Eastern Daylight Time	07/30/2022 06:55:32 AM Eastern Daylight Time			08/04/2022 02:08:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-039 (PPO)	01	04		1			H5216	039	0	2023	Select Counties in Nevada		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 10:24:49 AM Eastern Daylight Time	08/03/2022 03:41:09 PM Eastern Daylight Time	07/30/2022 06:55:56 AM Eastern Daylight Time			08/04/2022 01:48:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-042 (PPO)	01	04		1			H5216	042	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 12:44:53 PM Eastern Daylight Time	08/03/2022 03:41:37 PM Eastern Daylight Time	08/02/2022 10:08:40 AM Eastern Daylight Time			08/04/2022 01:21:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-043 (PPO)	01	04		1			H5216	043	1	2023	Select Counties in Texas	Select Counties in Texas	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	04	01	H5216_043_5	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:08:37 PM Eastern Daylight Time	08/03/2022 03:42:02 PM Eastern Daylight Time	08/02/2022 10:09:28 AM Eastern Daylight Time			08/04/2022 01:21:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-043 (PPO)	01	04		1			H5216	043	5	2023	Select Counties in Texas	Select Counties in Texas	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	04	01	H5216_043_6	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:09:11 PM Eastern Daylight Time	08/03/2022 03:55:36 PM Eastern Daylight Time	08/02/2022 10:10:16 AM Eastern Daylight Time			08/04/2022 01:21:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-043 (PPO)	01	04		1			H5216	043	6	2023	Select Counties in Texas	Select Counties in Texas	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/03/2022	2023.01	08/03/2022 11:41:12 AM Eastern Daylight Time	08/03/2022 03:39:57 PM Eastern Daylight Time	07/30/2022 06:56:46 AM Eastern Daylight Time			08/04/2022 11:15:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-044 (PPO)	01	04		1			H5216	044	0	2023	Select counties in Idaho and Oregon		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/30/2022	2023.01	05/30/2022 08:29:24 AM Eastern Daylight Time	08/03/2022 03:43:12 PM Eastern Daylight Time	07/30/2022 06:57:10 AM Eastern Daylight Time			08/04/2022 11:15:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-047 (PPO)	01	04		1			H5216	047	0	2023	Select Counties in OR, WA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		0	05/29/2022	2023.01	05/29/2022 09:33:07 PM Eastern Daylight Time	08/03/2022 03:45:02 PM Eastern Daylight Time	07/30/2022 06:57:34 AM Eastern Daylight Time			08/04/2022 11:15:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-048 (PPO)	01	04		1			H5216	048	0	2023	Select counties in ID, OR and WA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/13/2022	2023.01	07/13/2022 04:13:10 PM Eastern Daylight Time	08/03/2022 04:22:36 PM Eastern Daylight Time	07/30/2022 06:58:00 AM Eastern Daylight Time			08/04/2022 12:42:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-050 (PPO)	01	04		1			H5216	050	0	2023	Northwest Ohio Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/29/2022	2023.01	05/29/2022 04:38:19 PM Eastern Daylight Time	08/03/2022 04:22:07 PM Eastern Daylight Time	07/30/2022 06:58:26 AM Eastern Daylight Time			08/04/2022 12:42:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-051 (PPO)	01	04		1			H5216	051	0	2023	Canton-Youngstown Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/29/2022	2023.01	05/29/2022 04:57:30 PM Eastern Daylight Time	08/03/2022 04:34:31 PM Eastern Daylight Time	07/30/2022 06:58:50 AM Eastern Daylight Time			08/04/2022 12:42:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-052 (PPO)	01	04		1			H5216	052	1	2023	Select counties in Ohio	Ohio Valley - OH	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/28/2022	2023.01	05/28/2022 09:37:46 AM Eastern Daylight Time	08/03/2022 04:33:34 PM Eastern Daylight Time	07/30/2022 06:59:16 AM Eastern Daylight Time			08/04/2022 12:42:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-052 (PPO)	01	04		1			H5216	052	2	2023	Select counties in Ohio	Ohio Valley - WV	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/30/2022	2023.01	05/30/2022 07:42:12 PM Eastern Daylight Time	08/03/2022 04:23:05 PM Eastern Daylight Time	07/30/2022 06:59:40 AM Eastern Daylight Time			08/04/2022 12:05:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-053 (PPO)	01	04		1			H5216	053	0	2023	Central Indiana Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/28/2022	2023.01	05/28/2022 09:23:41 AM Eastern Daylight Time	08/03/2022 04:21:08 PM Eastern Daylight Time	07/30/2022 07:00:06 AM Eastern Daylight Time			08/04/2022 12:05:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-055 (PPO)	01	04		1			H5216	055	0	2023	Northern Indiana Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/29/2022	2023.01	05/29/2022 10:42:26 AM Eastern Daylight Time	08/03/2022 03:39:24 PM Eastern Daylight Time	07/30/2022 07:00:32 AM Eastern Daylight Time			08/04/2022 03:23:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-057 (PPO)	01	04		1			H5216	057	0	2023	New Hampshire and Select Counties in Vermont		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/03/2022	2023.01	08/03/2022 04:47:13 PM Eastern Daylight Time	08/03/2022 03:40:26 PM Eastern Daylight Time	07/30/2022 07:00:56 AM Eastern Daylight Time			08/04/2022 03:23:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-058 (PPO)	01	04		1			H5216	058	0	2023	New Hampshire and Select Counties in Vermont		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	059	0	1	04	01	H5216_059_0	2	1			2	0	0	05/28/2022	2023.01	05/28/2022 11:02:27 AM Eastern Daylight Time	06/01/2022 11:08:08 AM Eastern Daylight Time				06/02/2022 10:21:22 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	059	0	2023	ME and NH. Select Counties in CT, MA, and VT		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1		1	08/03/2022	2023.01	08/03/2022 04:28:28 PM Eastern Daylight Time	08/03/2022 05:26:02 PM Eastern Daylight Time	07/30/2022 07:01:20 AM Eastern Daylight Time			08/04/2022 01:45:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-062 (PPO)	01	04		1			H5216	062	0	2023	Select Counties in Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 12:00:55 PM Eastern Daylight Time	08/03/2022 03:57:44 PM Eastern Daylight Time	07/30/2022 07:01:44 AM Eastern Daylight Time			08/04/2022 11:43:15 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-063 (PPO)	01	04		1			H5216	063	0	2023	Select Counties in Minnesota		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/07/2022	2023.01	07/07/2022 10:48:29 AM Eastern Daylight Time	08/03/2022 03:55:34 PM Eastern Daylight Time	07/30/2022 07:02:10 AM Eastern Daylight Time			08/04/2022 02:28:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-064 (PPO)	01	04		1			H5216	064	0	2023	Select Louisiana Parishes		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/03/2022	2023.01	08/03/2022 04:30:58 PM Eastern Daylight Time	08/03/2022 05:25:35 PM Eastern Daylight Time	07/30/2022 07:02:36 AM Eastern Daylight Time			08/04/2022 01:45:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-068 (PPO)	01	04		1			H5216	068	0	2023	Broward, Miami-Dade and Palm Beach Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/04/2022	2023.01	08/04/2022 03:28:27 PM Eastern Daylight Time	08/03/2022 05:43:54 PM Eastern Daylight Time	07/30/2022 07:03:00 AM Eastern Daylight Time			08/04/2022 04:08:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-070 (PPO)	01	04		1			H5216	070	0	2023	North and Rural Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/04/2022	2023.01	08/04/2022 03:40:21 PM Eastern Daylight Time	08/03/2022 05:42:39 PM Eastern Daylight Time	07/30/2022 07:03:26 AM Eastern Daylight Time			08/04/2022 04:12:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-072 (PPO)	01	04		1			H5216	072	0	2023	Central Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	073	0	1	04	01	H5216_073_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 02:02:13 PM Eastern Daylight Time	08/03/2022 05:26:44 PM Eastern Daylight Time	07/30/2022 07:03:50 AM Eastern Daylight Time			08/04/2022 03:29:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-073 (PPO)	01	04		1			H5216	073	0	2023	Atlanta Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/04/2022	2023.01	08/04/2022 03:28:39 PM Eastern Daylight Time	08/03/2022 05:43:16 PM Eastern Daylight Time	07/30/2022 07:04:16 AM Eastern Daylight Time			08/04/2022 04:08:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-074 (PPO)	01	04		1			H5216	074	0	2023	Lake, Marion and Sumter counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	077	0	1	04	01	H5216_077_0	4	1			2	0	0	05/30/2022	2023.01	05/30/2022 07:28:43 PM Eastern Daylight Time	07/18/2022 05:44:27 PM Eastern Daylight Time				07/20/2022 01:25:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-077 (PPO)	01	04		1			H5216	077	0	2023	Select Counties in Colorado and New Mexico		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	078	1	1	04	01	H5216_078_1	3	1			1		1	05/28/2022	2023.01	05/28/2022 10:48:22 AM Eastern Daylight Time	08/03/2022 03:43:26 PM Eastern Daylight Time	07/30/2022 07:04:40 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-078 (PPO)	01	04		1			H5216	078	1	2023	Select Counties in Colorado	Select Counties in Colorado	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	078	2	1	04	01	H5216_078_2	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:39:00 PM Eastern Daylight Time	08/03/2022 03:44:39 PM Eastern Daylight Time	07/30/2022 07:05:06 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-078 (PPO)	01	04		1			H5216	078	2	2023	Select Counties in Colorado	Colorado New Mexico	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/13/2022	2023.01	07/13/2022 03:34:37 PM Eastern Daylight Time	08/03/2022 03:47:26 PM Eastern Daylight Time	07/30/2022 07:05:30 AM Eastern Daylight Time			08/04/2022 10:43:49 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-081 (PPO)	01	04		1			H5216	081	0	2023	Select Counties in Oklahoma		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	083	0	1	04	01	H5216_083_0	3	1			1		1	07/13/2022	2023.01	07/13/2022 04:23:52 PM Eastern Daylight Time	08/03/2022 03:47:56 PM Eastern Daylight Time	07/30/2022 07:05:56 AM Eastern Daylight Time			08/04/2022 11:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-083 (PPO)	01	04		1			H5216	083	0	2023	Select Counties in AR, KS, MO, and OK		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 07:47:13 PM Eastern Daylight Time	08/03/2022 03:47:17 PM Eastern Daylight Time	07/30/2022 07:06:20 AM Eastern Daylight Time			08/04/2022 11:04:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-088 (PPO)	01	04		1			H5216	088	0	2023	Select Counties in North and South Dakota		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/29/2022	2023.01	05/29/2022 09:34:08 PM Eastern Daylight Time	08/03/2022 03:46:24 PM Eastern Daylight Time	07/30/2022 07:06:44 AM Eastern Daylight Time			08/04/2022 11:15:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-089 (PPO)	01	04		1			H5216	089	0	2023	Select Counties in Montana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 12:01:56 PM Eastern Daylight Time	08/03/2022 03:54:11 PM Eastern Daylight Time	07/30/2022 07:07:10 AM Eastern Daylight Time			08/04/2022 11:43:15 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-092 (PPO)	01	04		1			H5216	092	0	2023	Select Counties in MN, ND and SD		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 12:46:39 PM Eastern Daylight Time	08/03/2022 03:56:22 PM Eastern Daylight Time	07/30/2022 07:07:34 AM Eastern Daylight Time			08/04/2022 12:04:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-093 (PPO)	01	04		1			H5216	093	0	2023	Memphis Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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		1	06/02/2022	2023.01	06/02/2022 07:03:02 PM Eastern Daylight Time	08/03/2022 04:01:47 PM Eastern Daylight Time	07/30/2022 07:08:00 AM Eastern Daylight Time			08/04/2022 12:40:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-096 (PPO)	01	04		1			H5216	096	0	2023	Dothan Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	097	0	1	04	01	H5216_097_0	3	1			1		1	07/13/2022	2023.01	07/13/2022 04:54:33 PM Eastern Daylight Time	08/03/2022 03:57:32 PM Eastern Daylight Time	07/30/2022 07:08:24 AM Eastern Daylight Time			08/04/2022 12:04:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-097 (PPO)	01	04		1			H5216	097	0	2023	Nashville Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/20/2022	2023.01	07/20/2022 03:44:57 PM Eastern Daylight Time	08/03/2022 03:58:36 PM Eastern Daylight Time	07/30/2022 07:08:50 AM Eastern Daylight Time			08/04/2022 12:04:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-098 (PPO)	01	04		1			H5216	098	0	2023	Chattanooga Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/30/2022	2023.01	05/30/2022 06:44:56 PM Eastern Daylight Time	08/03/2022 03:59:41 PM Eastern Daylight Time	07/30/2022 07:09:14 AM Eastern Daylight Time			08/04/2022 12:04:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-099 (PPO)	01	04		1			H5216	099	0	2023	Knoxville Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/13/2022	2023.01	07/13/2022 05:48:10 PM Eastern Daylight Time	08/04/2022 04:47:25 PM Eastern Daylight Time	07/30/2022 07:09:38 AM Eastern Daylight Time			08/04/2022 06:01:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-100 (PPO)	01	04		1			H5216	100	0	2023	Select Counties in the Tri-Cities Area of Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/29/2022	2023.01	05/29/2022 01:05:15 PM Eastern Daylight Time	08/03/2022 03:59:52 PM Eastern Daylight Time	07/30/2022 07:10:04 AM Eastern Daylight Time			08/04/2022 11:04:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-103 (PPO)	01	04		1			H5216	103	0	2023	Select Counties in North Dakota and South Dakota		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/28/2022	2023.01	05/28/2022 12:00:49 PM Eastern Daylight Time	07/18/2022 04:52:18 PM Eastern Daylight Time				07/20/2022 01:55:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-105 (PPO)	01	04		1			H5216	105	0	2023	Kentucky and West Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1			1		1	05/28/2022	2023.01	05/28/2022 09:37:58 AM Eastern Daylight Time	08/03/2022 04:34:59 PM Eastern Daylight Time	07/30/2022 07:10:28 AM Eastern Daylight Time			08/04/2022 12:42:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-106 (PPO)	01	04		1			H5216	106	0	2023	Select counties in Northeast Ohio		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/30/2022	2023.01	05/30/2022 01:41:52 PM Eastern Daylight Time	08/03/2022 04:42:01 PM Eastern Daylight Time	07/30/2022 07:10:54 AM Eastern Daylight Time			08/04/2022 04:46:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-107 (PPO)	01	04		1			H5216	107	0	2023	Select counties in Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 03:40:27 PM Eastern Daylight Time	08/03/2022 04:35:56 PM Eastern Daylight Time	07/30/2022 07:11:18 AM Eastern Daylight Time			08/04/2022 12:05:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-112 (PPO)	01	04		1			H5216	112	0	2023	Select counties in Northeast and Fort Wayne IN		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 03:40:56 PM Eastern Daylight Time	08/03/2022 04:35:27 PM Eastern Daylight Time	07/30/2022 07:11:42 AM Eastern Daylight Time			08/04/2022 12:05:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-114 (PPO)	01	04		1			H5216	114	0	2023	Select counties in Indianapolis		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	116	0	1	04	01	H5216_116_0	2	1				0	0	05/28/2022	2023.01	05/28/2022 10:55:16 AM Eastern Daylight Time	07/18/2022 04:52:51 PM Eastern Daylight Time				07/20/2022 01:42:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-116 (PPO)	01	04		1			H5216	116	0	2023	Select Counties in Pennsylvania and New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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		1	08/01/2022	2023.01	08/01/2022 01:32:32 PM Eastern Daylight Time	08/03/2022 04:43:36 PM Eastern Daylight Time	07/30/2022 07:12:08 AM Eastern Daylight Time			08/04/2022 06:27:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-117 (PPO)	01	04		1			H5216	117	0	2023	Greater Pittsburgh Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	120	0	1	04	01	H5216_120_0	5	1			1		1	07/22/2022	2023.01	07/22/2022 05:03:37 PM Eastern Daylight Time	08/03/2022 04:44:24 PM Eastern Daylight Time	07/30/2022 07:12:32 AM Eastern Daylight Time			08/04/2022 06:27:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-120 (PPO)	01	04		1			H5216	120	0	2023	South Central Pennsylvania Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/30/2022	2023.01	05/30/2022 02:17:15 PM Eastern Daylight Time	08/03/2022 04:42:49 PM Eastern Daylight Time	07/30/2022 07:12:58 AM Eastern Daylight Time			08/04/2022 06:27:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-124 (PPO)	01	04		1			H5216	124	0	2023	Select counties in West Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 03:37:19 PM Eastern Daylight Time	07/18/2022 05:05:04 PM Eastern Daylight Time				07/20/2022 03:33:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	128	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1			2	0	0	05/30/2022	2023.01	05/30/2022 07:42:40 AM Eastern Daylight Time	07/18/2022 05:07:45 PM Eastern Daylight Time				07/20/2022 03:11:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	129	0	2023	Delaware and Maryland		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1			1		1	08/03/2022	2023.01	08/03/2022 12:50:39 PM Eastern Daylight Time	08/03/2022 03:50:04 PM Eastern Daylight Time	07/30/2022 07:13:22 AM Eastern Daylight Time			08/04/2022 11:15:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-131 (PPO)	01	04		1			H5216	131	0	2023	Select Counties in UT		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 11:07:28 AM Eastern Daylight Time	08/03/2022 03:50:32 PM Eastern Daylight Time	07/30/2022 07:13:48 AM Eastern Daylight Time			08/04/2022 11:15:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-132 (PPO)	01	04		1			H5216	132	0	2023	Select Counties in ID, OR		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	133	0	1	04	01	H5216_133_0	4	1			1		1	05/29/2022	2023.01	05/29/2022 12:00:29 PM Eastern Daylight Time	08/03/2022 04:37:20 PM Eastern Daylight Time	07/30/2022 07:14:12 AM Eastern Daylight Time			08/04/2022 12:05:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-133 (PPO)	01	04		1			H5216	133	0	2023	Macomb, Oakland and Wayne counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	136	0	1	04	01	H5216_136_0	3	1			1		1	07/07/2022	2023.01	07/07/2022 10:49:55 AM Eastern Daylight Time	08/03/2022 03:57:27 PM Eastern Daylight Time	07/30/2022 07:14:38 AM Eastern Daylight Time			08/04/2022 02:28:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-136 (PPO)	01	04		1			H5216	136	0	2023	Select Counties in Mississippi		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:39:30 PM Eastern Daylight Time	08/03/2022 03:47:18 PM Eastern Daylight Time	07/30/2022 07:15:02 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-137 (PPO)	01	04		1			H5216	137	0	2023	Select Counties in New Mexico, Colorado, & Arizona		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/02/2022	2023.01	08/02/2022 10:30:03 AM Eastern Daylight Time	08/03/2022 03:42:31 PM Eastern Daylight Time	07/30/2022 07:15:26 AM Eastern Daylight Time			08/04/2022 03:23:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-138 (PPO)	01	04		1			H5216	138	0	2023	ME and NH. Select Counties in MA and VT		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/31/2022	2023.01	05/31/2022 01:59:34 PM Eastern Daylight Time	07/18/2022 05:05:55 PM Eastern Daylight Time				07/20/2022 01:31:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	140	0	2023	Select Counties in AR, IL, KS, MO, and OK		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1		0	08/01/2022	2023.01	08/01/2022 03:00:25 PM Eastern Daylight Time	08/03/2022 04:11:48 PM Eastern Daylight Time	07/30/2022 07:15:50 AM Eastern Daylight Time			08/04/2022 02:08:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-141 (PPO)	01	04		1			H5216	141	0	2023	Clark and Nye Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	142	1	1	04	01	H5216_142_1	3	1			1		1	08/02/2022	2023.01	08/02/2022 10:24:35 AM Eastern Daylight Time	08/03/2022 05:28:55 PM Eastern Daylight Time	07/30/2022 07:16:16 AM Eastern Daylight Time			08/04/2022 03:48:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-142 (PPO)	01	04		1			H5216	142	1	2023	Select Counties in Georgia and South Carolina	Select counties in Georgia and South Carolina	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	142	2	1	04	01	H5216_142_2	3	1			1		1	08/02/2022	2023.01	08/02/2022 12:59:10 PM Eastern Daylight Time	08/03/2022 05:29:22 PM Eastern Daylight Time	07/30/2022 07:16:40 AM Eastern Daylight Time			08/04/2022 03:48:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-142 (PPO)	01	04		1			H5216	142	2	2023	Select Counties in Georgia and South Carolina	Select Counties in Georgia and South Carolina	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/13/2022	2023.01	07/13/2022 03:28:18 PM Eastern Daylight Time	08/03/2022 04:11:11 PM Eastern Daylight Time	07/30/2022 07:17:06 AM Eastern Daylight Time			08/04/2022 04:33:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-144 (PPO)	01	04		1			H5216	144	0	2023	Richmond-Tidewater Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	149	0	1	04	01	H5216_149_0	4	1			1		1	08/02/2022	2023.01	08/02/2022 10:20:41 AM Eastern Daylight Time	08/03/2022 04:10:13 PM Eastern Daylight Time	07/30/2022 07:17:30 AM Eastern Daylight Time			08/04/2022 04:33:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-149 (PPO)	01	04		1			H5216	149	0	2023	Lynchburg, Winchester and surrounding areas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	152	0	1	04	01	H5216_152_0	3	1			2	0	0	07/22/2022	2023.01	07/22/2022 04:45:41 PM Eastern Daylight Time	07/18/2022 05:13:09 PM Eastern Daylight Time				07/22/2022 05:03:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-152 (PPO)	01	04		1			H5216	152	0	2023	Select counties in Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 01:00:38 PM Eastern Daylight Time	08/03/2022 05:29:48 PM Eastern Daylight Time	07/30/2022 07:17:56 AM Eastern Daylight Time			08/04/2022 03:48:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-154 (PPO)	01	04		1			H5216	154	0	2023	Select Counties in Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/28/2022	2023.01	05/28/2022 03:58:45 PM Eastern Daylight Time	07/18/2022 05:13:40 PM Eastern Daylight Time				07/20/2022 02:11:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-157 (PPO)	01	04		1			H5216	157	0	2023	Select Counties in Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	160	0	1	04	01	H5216_160_0	3	1			1		0	06/02/2022	2023.01	06/02/2022 04:05:03 PM Eastern Daylight Time	08/03/2022 03:58:50 PM Eastern Daylight Time	07/30/2022 07:18:20 AM Eastern Daylight Time			08/04/2022 02:28:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-160 (PPO)	01	04		1			H5216	160	0	2023	Select Counties in Mississippi		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	161	0	1	04	01	H5216_161_0	3	1			1		0	08/02/2022	2023.01	08/02/2022 11:54:45 AM Eastern Daylight Time	08/03/2022 03:59:18 PM Eastern Daylight Time	07/30/2022 07:18:44 AM Eastern Daylight Time			08/04/2022 02:28:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-161 (PPO)	01	04		1			H5216	161	0	2023	Select Louisiana Parishes		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 09:01:03 AM Eastern Daylight Time	08/03/2022 03:48:24 PM Eastern Daylight Time	07/30/2022 07:19:10 AM Eastern Daylight Time			08/04/2022 10:43:49 AM 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	2023	Select Counties in Missouri		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	06/03/2022	2023.01	06/03/2022 01:48:54 PM Eastern Daylight Time	08/03/2022 04:01:06 PM Eastern Daylight Time	07/30/2022 07:19:34 AM Eastern Daylight Time			08/04/2022 11:04:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-167 (PPO)	01	04		1			H5216	167	0	2023	Select Counties in Minnesota		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/30/2022	2023.01	05/30/2022 11:08:08 AM Eastern Daylight Time	08/03/2022 04:02:08 PM Eastern Daylight Time	07/30/2022 07:20:00 AM Eastern Daylight Time			08/04/2022 11:43:15 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-168 (PPO)	01	04		1			H5216	168	0	2023	Select Counties in Wisconsin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 01:11:46 PM Eastern Daylight Time	08/03/2022 03:43:33 PM Eastern Daylight Time	07/30/2022 07:20:26 AM Eastern Daylight Time			08/04/2022 03:11:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-169 (PPO)	01	04		1			H5216	169	0	2023	Select Counties in New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	06/01/2022	2023.01	06/01/2022 02:57:57 PM Eastern Daylight Time	08/03/2022 03:43:02 PM Eastern Daylight Time	07/30/2022 07:20:50 AM Eastern Daylight Time			08/04/2022 03:11:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-170 (PPO)	01	04		1			H5216	170	0	2023	Select Counties in New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		0	05/31/2022	2023.01	05/31/2022 03:00:37 PM Eastern Daylight Time	08/03/2022 03:49:28 PM Eastern Daylight Time	07/30/2022 07:21:14 AM Eastern Daylight Time			08/04/2022 11:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-171 (PPO)	01	04		1			H5216	171	0	2023	Select Counties in IA, NE, ND, and SD		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		0	08/01/2022	2023.01	08/01/2022 01:13:45 PM Eastern Daylight Time	08/03/2022 03:44:03 PM Eastern Daylight Time	07/30/2022 07:21:40 AM Eastern Daylight Time			08/04/2022 03:11:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-172 (PPO)	01	04		1			H5216	172	0	2023	Select Counties in New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		0	07/13/2022	2023.01	07/13/2022 04:07:32 PM Eastern Daylight Time	08/03/2022 04:03:19 PM Eastern Daylight Time	07/30/2022 07:22:04 AM Eastern Daylight Time			08/04/2022 11:43:15 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-173 (PPO)	01	04		1			H5216	173	0	2023	Select Counties in Wisconsin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1	1			2	0	0	05/28/2022	2023.01	05/28/2022 10:29:43 AM Eastern Daylight Time	06/01/2022 11:11:03 AM Eastern Daylight Time				06/02/2022 09:11:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	174	0	2023	Select Counties in New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 07:43:49 PM Eastern Daylight Time	08/03/2022 03:44:35 PM Eastern Daylight Time	07/30/2022 07:22:28 AM Eastern Daylight Time			08/04/2022 02:54:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-175 (PPO)	01	04		1			H5216	175	0	2023	Maine		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		0	05/29/2022	2023.01	05/29/2022 01:03:03 PM Eastern Daylight Time	08/03/2022 04:04:33 PM Eastern Daylight Time	07/30/2022 07:22:54 AM Eastern Daylight Time			08/04/2022 11:43:15 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-176 (PPO)	01	04		1			H5216	176	0	2023	Select Counties in Minnesota		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 12:04:26 PM Eastern Daylight Time	08/03/2022 03:45:06 PM Eastern Daylight Time	07/30/2022 07:23:18 AM Eastern Daylight Time			08/04/2022 02:54:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-177 (PPO)	01	04		1			H5216	177	0	2023	Maine		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:10:39 PM Eastern Daylight Time	08/03/2022 04:07:43 PM Eastern Daylight Time	07/30/2022 07:23:44 AM Eastern Daylight Time			08/04/2022 12:40:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-179 (PPO)	01	04		1			H5216	179	0	2023	Select Counties in Alabama		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	180	0	1	04	01	H5216_180_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:59:05 PM Eastern Daylight Time	08/03/2022 04:06:25 PM Eastern Daylight Time	07/30/2022 07:24:08 AM Eastern Daylight Time			08/04/2022 12:28:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-180 (PPO)	01	04		1			H5216	180	0	2023	Select Counties in TN		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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		1	05/30/2022	2023.01	05/30/2022 01:33:39 PM Eastern Daylight Time	08/03/2022 04:48:16 PM Eastern Daylight Time	07/30/2022 07:24:34 AM Eastern Daylight Time			08/04/2022 06:27:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-182 (PPO)	01	04		1			H5216	182	0	2023	West Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	185	0	1	04	01	H5216_185_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:35:42 PM Eastern Daylight Time	08/03/2022 04:49:01 PM Eastern Daylight Time	07/30/2022 07:24:58 AM Eastern Daylight Time			08/04/2022 04:46:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-185 (PPO)	01	04		1			H5216	185	0	2023	Select Counties in New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/07/2022	2023.01	07/07/2022 10:45:18 AM Eastern Daylight Time	08/03/2022 04:49:45 PM Eastern Daylight Time	07/30/2022 07:25:24 AM Eastern Daylight Time			08/04/2022 04:46:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-186 (PPO)	01	04		1			H5216	186	0	2023	Select Counties in New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	188	0	1	04	01	H5216_188_0	3	1			1		1	05/30/2022	2023.01	05/30/2022 03:30:52 PM Eastern Daylight Time	08/03/2022 04:45:57 PM Eastern Daylight Time	07/30/2022 07:25:48 AM Eastern Daylight Time			08/04/2022 04:46:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-188 (PPO)	01	04		1			H5216	188	0	2023	Select Counties in Indiana and Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/29/2022	2023.01	05/29/2022 09:37:06 PM Eastern Daylight Time	08/03/2022 03:51:26 PM Eastern Daylight Time	07/30/2022 07:26:14 AM Eastern Daylight Time			08/04/2022 11:15:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-189 (PPO)	01	04		1			H5216	189	0	2023	Select Counties in UT		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 01:03:44 PM Eastern Daylight Time	07/18/2022 05:20:45 PM Eastern Daylight Time				07/20/2022 02:31:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	190	0	2023	Select counties in Michigan		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	08/01/2022	2023.01	08/01/2022 02:08:36 PM Eastern Daylight Time	08/03/2022 04:39:44 PM Eastern Daylight Time	07/30/2022 07:26:38 AM Eastern Daylight Time			08/04/2022 12:05:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-192 (PPO)	01	04		1			H5216	192	0	2023	Select counties in Indiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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		1	08/01/2022	2023.01	08/01/2022 01:19:07 PM Eastern Daylight Time	08/03/2022 04:41:12 PM Eastern Daylight Time	07/30/2022 07:27:02 AM Eastern Daylight Time			08/04/2022 11:51:45 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-193 (PPO)	01	04		1			H5216	193	0	2023	Select counties in Indiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		0	08/01/2022	2023.01	08/01/2022 03:00:46 PM Eastern Daylight Time	08/03/2022 04:15:15 PM Eastern Daylight Time	07/30/2022 07:27:28 AM Eastern Daylight Time			08/04/2022 02:08:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-194 (PPO)	01	04		1			H5216	194	0	2023	Select Counties in Nevada		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/31/2022	2023.01	07/31/2022 01:20:16 PM Eastern Daylight Time	08/03/2022 04:03:22 PM Eastern Daylight Time	07/30/2022 07:27:54 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-195 (PPO)	01	04		1			H5216	195	0	2023	Colorado		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:40:08 PM Eastern Daylight Time	08/03/2022 03:45:48 PM Eastern Daylight Time	07/30/2022 07:28:18 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-196 (PPO)	01	04		1			H5216	196	1	2023	New Mexico	Southern New Mexico	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	04	01	H5216_196_2	3	1			1		1	07/07/2022	2023.01	07/07/2022 12:40:10 PM Eastern Daylight Time	08/03/2022 03:57:42 PM Eastern Daylight Time	07/30/2022 07:28:44 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-196 (PPO)	01	04		1			H5216	196	2	2023	New Mexico	Greater New Mexico	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	197	0	1	04	01	H5216_197_0	4	1			1		0	07/21/2022	2023.01	07/21/2022 12:05:19 PM Eastern Daylight Time	08/03/2022 03:48:31 PM Eastern Daylight Time	07/30/2022 07:29:08 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-197 (PPO)	01	04		1			H5216	197	0	2023	Select counties in Arizona		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/07/2022	2023.01	07/07/2022 12:41:26 PM Eastern Daylight Time	08/03/2022 03:49:44 PM Eastern Daylight Time	07/30/2022 07:29:34 AM Eastern Daylight Time			08/04/2022 03:34:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-198 (PPO)	01	04		1			H5216	198	0	2023	Select Counties in Arizona		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/21/2022	2023.01	07/21/2022 12:05:42 PM Eastern Daylight Time	08/03/2022 03:56:31 PM Eastern Daylight Time	07/30/2022 07:29:58 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-199 (PPO)	01	04		1			H5216	199	0	2023	Select counties in New Mexico		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1	0	0	05/28/2022	2023.01	05/28/2022 10:01:30 AM Eastern Daylight Time	07/18/2022 06:00:01 PM Eastern Daylight Time				07/20/2022 01:40:48 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	200	0	2023	Select Counties in Mississippi		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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			1	0	0	05/28/2022	2023.01	05/28/2022 10:01:46 AM Eastern Daylight Time	07/18/2022 05:58:43 PM Eastern Daylight Time				07/20/2022 01:40:48 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	201	0	2023	Louisiana Statewide		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	203	1	1	04	01	H5216_203_1	4	1			1		1	08/02/2022	2023.01	08/02/2022 01:07:42 PM Eastern Daylight Time	08/03/2022 05:31:31 PM Eastern Daylight Time	07/30/2022 07:30:24 AM Eastern Daylight Time			08/04/2022 03:29:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-203 (PPO)	01	04		1			H5216	203	1	2023	Select counties in Georgia	Select counties in Georgia	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/02/2022	2023.01	08/02/2022 01:08:07 PM Eastern Daylight Time	08/03/2022 05:31:58 PM Eastern Daylight Time	07/30/2022 07:30:50 AM Eastern Daylight Time			08/04/2022 03:29:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-203 (PPO)	01	04		1			H5216	203	2	2023	Select counties in Georgia	Macon and Albany Area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 05:06:14 PM Eastern Daylight Time	08/03/2022 05:30:14 PM Eastern Daylight Time	07/30/2022 07:31:14 AM Eastern Daylight Time			08/04/2022 05:38:43 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	2023	Select Counties in Georgia		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/04/2022	2023.01	08/04/2022 07:07:01 PM Eastern Daylight Time	08/03/2022 05:30:39 PM Eastern Daylight Time	07/30/2022 07:31:40 AM Eastern Daylight Time			08/04/2022 07:47:06 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	2023	Select Counties in Georgia		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/04/2022	2023.01	08/04/2022 07:35:10 PM Eastern Daylight Time	08/03/2022 05:31:05 PM Eastern Daylight Time	07/30/2022 07:32:06 AM Eastern Daylight Time			08/04/2022 07:47:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-207 (PPO)	01	04		1			H5216	207	0	2023	Select Counties in Georgia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:26:39 PM Eastern Daylight Time	08/03/2022 04:13:28 PM Eastern Daylight Time	07/30/2022 07:32:32 AM Eastern Daylight Time			08/04/2022 02:59:41 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-211 (PPO)	01	04		1			H5216	211	0	2023	North Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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		1	08/01/2022	2023.01	08/01/2022 01:11:04 PM Eastern Daylight Time	08/03/2022 04:09:48 PM Eastern Daylight Time	07/30/2022 07:32:56 AM Eastern Daylight Time			08/04/2022 12:40:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-212 (PPO)	01	04		1			H5216	212	0	2023	East Alabama		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/30/2022	2023.01	05/30/2022 02:45:01 PM Eastern Daylight Time	07/18/2022 05:56:36 PM Eastern Daylight Time				07/20/2022 01:14:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	213	0	2023	Select Counties in Arizona, Colorado, New Mexico		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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		1	08/01/2022	2023.01	08/01/2022 01:11:25 PM Eastern Daylight Time	08/03/2022 04:13:05 PM Eastern Daylight Time	07/30/2022 07:33:20 AM Eastern Daylight Time			08/04/2022 12:40:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-214 (PPO)	01	04		1			H5216	214	1	2023	Select Counties in Alabama	Select Counties in Alabama	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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		1	05/28/2022	2023.01	05/28/2022 01:02:26 PM Eastern Daylight Time	08/03/2022 04:12:01 PM Eastern Daylight Time	07/30/2022 07:33:46 AM Eastern Daylight Time			08/04/2022 12:40:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-214 (PPO)	01	04		1			H5216	214	2	2023	Select Counties in Alabama	Select Counties in Alabama	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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		1	05/28/2022	2023.01	05/28/2022 01:03:01 PM Eastern Daylight Time	08/03/2022 04:10:51 PM Eastern Daylight Time	07/30/2022 07:34:10 AM Eastern Daylight Time			08/04/2022 12:40:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-214 (PPO)	01	04		1			H5216	214	3	2023	Select Counties in Alabama	Select Counties in Alabama	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 12:54:29 PM Eastern Daylight Time	08/03/2022 04:07:45 PM Eastern Daylight Time	07/30/2022 07:34:36 AM Eastern Daylight Time			08/04/2022 11:43:15 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-215 (PPO)	01	04		1			H5216	215	0	2023	Select Counties in Illinois		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/28/2022	2023.01	05/28/2022 10:47:20 AM Eastern Daylight Time	07/18/2022 06:42:18 PM Eastern Daylight Time				07/20/2022 02:57:10 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	216	0	2023	Select Counties in Nevada		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/28/2022	2023.01	05/28/2022 03:59:07 PM Eastern Daylight Time	07/18/2022 05:18:43 PM Eastern Daylight Time				07/20/2022 02:11:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	217	0	2023	Select Counties in Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/28/2022	2023.01	05/28/2022 09:27:08 AM Eastern Daylight Time	07/18/2022 05:26:38 PM Eastern Daylight Time				07/20/2022 03:17:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	218	0	2023	States of Indiana and Ohio		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 05:42:54 PM Eastern Daylight Time	08/03/2022 03:53:04 PM Eastern Daylight Time	07/30/2022 07:35:00 AM Eastern Daylight Time			08/04/2022 11:11:59 AM 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	2023	Select Counties in Arkansas		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 01:34:28 PM Eastern Daylight Time	08/03/2022 04:52:44 PM Eastern Daylight Time	07/30/2022 07:35:26 AM Eastern Daylight Time			08/04/2022 06:27:42 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	2023	Select Counties in West Virginia		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/30/2022	2023.01	05/30/2022 11:06:29 AM Eastern Daylight Time	07/18/2022 04:59:17 PM Eastern Daylight Time				07/20/2022 01:42:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	221	0	2023	Select Counties in Pennsylvania and New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	223	0	1	04	01	H5216_223_0	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:11:51 PM Eastern Daylight Time	08/03/2022 04:06:54 PM Eastern Daylight Time	07/30/2022 07:35:50 AM Eastern Daylight Time			08/04/2022 03:15:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-223 (PPO)	01	04		1			H5216	223	0	2023	Greater Colorado		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	224	0	1	04	01	H5216_224_0	3	1			1		1	07/06/2022	2023.01	07/06/2022 01:09:34 PM Eastern Daylight Time	08/03/2022 04:05:36 PM Eastern Daylight Time	07/30/2022 07:36:16 AM Eastern Daylight Time			08/04/2022 03:15:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-224 (PPO)	01	04		1			H5216	224	0	2023	Southern Arizona		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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				0	0	05/28/2022	2023.01	05/28/2022 12:14:25 PM Eastern Daylight Time	07/18/2022 05:00:47 PM Eastern Daylight Time				07/20/2022 01:55:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	225	0	2023	Kentucky and West Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:36:44 PM Eastern Daylight Time	08/03/2022 04:55:46 PM Eastern Daylight Time	07/30/2022 07:36:40 AM Eastern Daylight Time			08/04/2022 04:46:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-226 (PPO)	01	04		1			H5216	226	0	2023	Rural Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 01:35:26 PM Eastern Daylight Time	08/03/2022 04:54:59 PM Eastern Daylight Time	07/30/2022 07:37:06 AM Eastern Daylight Time			08/04/2022 06:27:42 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	2023	Select Counties in Pennsylvania		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 09:02:53 AM Eastern Daylight Time	08/03/2022 03:58:56 PM Eastern Daylight Time	07/30/2022 07:37:30 AM Eastern Daylight Time			08/04/2022 10:51:29 AM 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	2023	Select Counties in Oklahoma		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:36:45 PM Eastern Daylight Time	08/03/2022 04:44:08 PM Eastern Daylight Time	07/30/2022 07:37:56 AM Eastern Daylight Time			08/04/2022 11:51:45 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-229 (PPO)	01	04		1			H5216	229	0	2023	Northwest/Southern Indiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:58:46 PM Eastern Daylight Time	08/03/2022 04:01:38 PM Eastern Daylight Time	07/30/2022 07:38:20 AM Eastern Daylight Time			08/04/2022 11:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-231 (PPO)	01	04		1			H5216	231	0	2023	Arkansas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 10:47:51 AM Eastern Daylight Time	08/03/2022 04:17:44 PM Eastern Daylight Time	07/30/2022 07:38:46 AM Eastern Daylight Time			08/04/2022 02:08:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-232 (PPO)	01	04		1			H5216	232	1	2023	Honolulu, Kauai and Maui counties	Honolulu County	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 08:58:15 AM Eastern Daylight Time	08/03/2022 04:18:13 PM Eastern Daylight Time	07/30/2022 07:39:10 AM Eastern Daylight Time			08/04/2022 02:08:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-232 (PPO)	01	04		1			H5216	232	2	2023	Honolulu, Kauai and Maui counties	Kauai and Maui counties	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 05:37:17 PM Eastern Daylight Time	08/03/2022 04:19:13 PM Eastern Daylight Time	07/30/2022 07:39:34 AM Eastern Daylight Time			08/04/2022 02:08:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-233 (PPO)	01	04		1			H5216	233	1	2023	Honolulu, Kauai and Maui counties	Honolulu County	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:02:22 PM Eastern Daylight Time	08/03/2022 04:18:43 PM Eastern Daylight Time	07/30/2022 07:40:00 AM Eastern Daylight Time			08/04/2022 02:08:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-233 (PPO)	01	04		1			H5216	233	2	2023	Honolulu, Kauai and Maui counties	Kauai and Maui counties	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/30/2022	2023.01	05/30/2022 01:27:30 PM Eastern Daylight Time	07/18/2022 06:46:39 PM Eastern Daylight Time				07/20/2022 02:57:10 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	234	0	2023	Honolulu County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1			2	0	0	05/28/2022	2023.01	05/28/2022 09:21:45 AM Eastern Daylight Time	07/18/2022 05:24:10 PM Eastern Daylight Time				07/20/2022 03:39:08 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	235	0	2023	Greater Tennessee		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/28/2022	2023.01	05/28/2022 09:25:44 AM Eastern Daylight Time	07/18/2022 05:25:22 PM Eastern Daylight Time				07/20/2022 01:37:10 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	236	0	2023	Greater Alabama		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	239	0	1	04	01	H5216_239_0	4	1			1		1	08/02/2022	2023.01	08/02/2022 01:08:26 PM Eastern Daylight Time	08/03/2022 05:33:16 PM Eastern Daylight Time	07/30/2022 07:40:26 AM Eastern Daylight Time			08/04/2022 03:29:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Care Extra (PPO)	01	04		1			H5216	239	0	2023	Atlanta Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 01:08:41 PM Eastern Daylight Time	08/03/2022 05:33:41 PM Eastern Daylight Time	07/30/2022 07:40:50 AM Eastern Daylight Time			08/04/2022 03:29:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Care Extra (PPO D-SNP)	01	04		1			H5216	240	0	2023	Atlanta Metro Area		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1		1	1		0	08/04/2022	2023.01	08/04/2022 05:15:50 PM Eastern Daylight Time	08/03/2022 05:34:33 PM Eastern Daylight Time	07/30/2022 07:41:16 AM Eastern Daylight Time			08/04/2022 05:38:43 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	2023	Select Counties in Georgia		2		2			1	1	1							https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		0	07/21/2022	2023.01	07/21/2022 11:14:04 AM Eastern Daylight Time	08/03/2022 05:35:26 PM Eastern Daylight Time	07/30/2022 07:41:40 AM Eastern Daylight Time			08/04/2022 03:48:12 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	2023	Upstate South Carolina		2		2			1	1	1							https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		1	08/02/2022	2023.01	08/02/2022 10:28:48 AM Eastern Daylight Time	08/03/2022 05:34:07 PM Eastern Daylight Time	07/30/2022 07:42:06 AM Eastern Daylight Time			08/04/2022 03:48:12 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	2023	South Carolina		2		2			1	4			00000000000000001000000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/04/2022	2023.01	08/04/2022 06:26:12 PM Eastern Daylight Time	08/03/2022 05:35:00 PM Eastern Daylight Time	07/30/2022 07:42:30 AM Eastern Daylight Time			08/04/2022 07:47:06 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	2023	Select Counties in Georgia		2		2			1	4			00000000000000001000000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/03/2022	2023.01	08/03/2022 11:41:57 AM Eastern Daylight Time	08/03/2022 03:51:54 PM Eastern Daylight Time	07/30/2022 07:42:56 AM Eastern Daylight Time			08/04/2022 11:15:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-247 (PPO)	01	04		1			H5216	247	0	2023	Select counties in ID,OR,UT,WA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 07:45:58 PM Eastern Daylight Time	08/03/2022 03:47:11 PM Eastern Daylight Time	07/30/2022 07:43:20 AM Eastern Daylight Time			08/04/2022 02:54:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-249 (PPO)	01	04		1			H5216	249	0	2023	Select Counties in Massachusetts		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/18/2022	2023.01	07/18/2022 01:08:03 PM Eastern Daylight Time	08/03/2022 03:46:40 PM Eastern Daylight Time	07/30/2022 07:43:46 AM Eastern Daylight Time			08/04/2022 02:54:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-250 (PPO)	01	04		1			H5216	250	0	2023	Select Counties in Massachusetts		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 12:55:37 PM Eastern Daylight Time	08/03/2022 04:10:53 PM Eastern Daylight Time	07/30/2022 07:44:10 AM Eastern Daylight Time			08/04/2022 11:43:15 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-251 (PPO)	01	04		1			H5216	251	0	2023	Select Counties in Illinois		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 12:53:31 PM Eastern Daylight Time	08/03/2022 04:11:59 PM Eastern Daylight Time	07/30/2022 07:44:34 AM Eastern Daylight Time			08/04/2022 11:50:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-252 (PPO)	01	04		1			H5216	252	0	2023	Select Counties in Eastern Wisconsin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/02/2022	2023.01	08/02/2022 12:58:48 PM Eastern Daylight Time	08/03/2022 04:13:11 PM Eastern Daylight Time	07/30/2022 07:45:00 AM Eastern Daylight Time			08/04/2022 11:50:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-253 (PPO)	01	04		1			H5216	253	0	2023	Select Counties in Eastern Wisconsin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:59:13 PM Eastern Daylight Time	08/03/2022 03:53:34 PM Eastern Daylight Time	07/30/2022 07:45:24 AM Eastern Daylight Time			08/04/2022 11:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-254 (PPO)	01	04		1			H5216	254	0	2023	Select Counties in Iowa and Nebraska		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 03:03:34 PM Eastern Daylight Time	08/03/2022 03:54:13 PM Eastern Daylight Time	07/30/2022 07:45:50 AM Eastern Daylight Time			08/04/2022 12:37:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-255 (PPO)	01	04		1			H5216	255	0	2023	Select Counties in MT		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			2	0	0	08/03/2022	2023.01	08/03/2022 04:32:43 PM Eastern Daylight Time	06/01/2022 10:38:34 AM Eastern Daylight Time				08/04/2022 02:19:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	256	0	2023	Select Counties in Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1			2	0	0	08/03/2022	2023.01	08/03/2022 02:27:48 PM Eastern Daylight Time	07/18/2022 05:22:46 PM Eastern Daylight Time				08/04/2022 02:00:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	257	0	2023	Central, North and Rural Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			2	0	0	06/03/2022	2023.01	06/03/2022 11:04:27 AM Eastern Daylight Time	07/18/2022 05:25:45 PM Eastern Daylight Time				07/20/2022 02:16:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	258	0	2023	Select Counties in IL, WI		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1			1		1	07/31/2022	2023.01	07/31/2022 01:12:41 PM Eastern Daylight Time	08/03/2022 04:11:21 PM Eastern Daylight Time	07/30/2022 07:46:14 AM Eastern Daylight Time			08/04/2022 03:15:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-260 (PPO)	01	04		1			H5216	260	0	2023	Select Counties in Arizona and New Mexico		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:13:34 PM Eastern Daylight Time	08/03/2022 04:08:01 PM Eastern Daylight Time	07/30/2022 07:46:40 AM Eastern Daylight Time			08/04/2022 03:15:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-261 (PPO)	01	04		1			H5216	261	0	2023	Denver and North Colorado		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:14:14 PM Eastern Daylight Time	08/03/2022 04:09:09 PM Eastern Daylight Time	07/30/2022 07:47:04 AM Eastern Daylight Time			08/04/2022 03:15:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-263 (PPO)	01	04		1			H5216	263	0	2023	Greater Arizona		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	08/01/2022	2023.01	08/01/2022 12:36:56 PM Eastern Daylight Time	08/03/2022 04:02:58 PM Eastern Daylight Time	07/30/2022 07:47:30 AM Eastern Daylight Time			08/04/2022 10:51:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-264 (PPO)	01	04		1			H5216	264	0	2023	Select Counties in Oklahoma		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2022	2023.01	07/31/2022 01:15:02 PM Eastern Daylight Time	08/03/2022 04:10:14 PM Eastern Daylight Time	07/30/2022 07:47:54 AM Eastern Daylight Time			08/04/2022 03:15:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-265 (PPO)	01	04		1			H5216	265	0	2023	Maricopa Pima Pinal		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:27:12 PM Eastern Daylight Time	08/03/2022 04:17:23 PM Eastern Daylight Time	07/30/2022 07:48:20 AM Eastern Daylight Time			08/04/2022 04:33:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-266 (PPO)	01	04		1			H5216	266	0	2023	Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 07:18:52 PM Eastern Daylight Time	08/03/2022 04:12:38 PM Eastern Daylight Time	07/30/2022 07:48:44 AM Eastern Daylight Time			08/04/2022 03:15:16 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	2023	Colorado		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/18/2022	2023.01	07/18/2022 12:33:33 PM Eastern Daylight Time	08/03/2022 04:04:19 PM Eastern Daylight Time	07/30/2022 07:49:10 AM Eastern Daylight Time			08/04/2022 11:11:59 AM 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	2023	Select Counties in Iowa		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:11:44 PM Eastern Daylight Time	08/03/2022 04:15:21 PM Eastern Daylight Time	07/30/2022 07:49:34 AM Eastern Daylight Time			08/04/2022 12:40:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-269 (PPO)	01	04		1			H5216	269	0	2023	Birmingham		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:12:15 PM Eastern Daylight Time	08/03/2022 04:17:26 PM Eastern Daylight Time	07/30/2022 07:50:00 AM Eastern Daylight Time			08/04/2022 12:40:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-271 (PPO)	01	04		1			H5216	271	0	2023	Select VA Counties in Tri-Cities Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:32:48 PM Eastern Daylight Time	08/03/2022 04:16:23 PM Eastern Daylight Time	07/30/2022 07:50:26 AM Eastern Daylight Time			08/04/2022 12:40:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-272 (PPO)	01	04		1			H5216	272	0	2023	Select Counties in Alabama		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2022	2023.01	08/02/2022 12:52:11 PM Eastern Daylight Time	08/03/2022 04:16:29 PM Eastern Daylight Time	07/30/2022 07:50:50 AM Eastern Daylight Time			08/04/2022 11:50:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-273 (PPO)	01	04		1			H5216	273	0	2023	Select Counties in ND/SD		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2022	2023.01	08/01/2022 01:08:07 PM Eastern Daylight Time	08/03/2022 04:19:58 PM Eastern Daylight Time	07/30/2022 07:51:14 AM Eastern Daylight Time			08/04/2022 12:28:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-274 (PPO)	01	04		1			H5216	274	0	2023	Nashville Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2022	2023.01	08/02/2022 12:58:00 PM Eastern Daylight Time	08/03/2022 04:14:10 PM Eastern Daylight Time	07/30/2022 07:51:38 AM Eastern Daylight Time			08/04/2022 11:50:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-275 (PPO)	01	04		1			H5216	275	0	2023	Twin Cities Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 08:03:49 PM Eastern Daylight Time	08/03/2022 05:35:52 PM Eastern Daylight Time	07/30/2022 07:52:04 AM Eastern Daylight Time			08/04/2022 03:48:12 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	2023	South Carolina		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	06/03/2022	2023.01	06/03/2022 11:05:16 AM Eastern Daylight Time	07/18/2022 05:34:26 PM Eastern Daylight Time				07/20/2022 02:16:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	278	1	2023	Select Counties in IA, MN, MT, NE, ND, SD	Select Counties in MN, ND, SD	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1			2	0	0	05/31/2022	2023.01	05/31/2022 06:28:17 AM Eastern Daylight Time	07/18/2022 05:16:59 PM Eastern Daylight Time				07/20/2022 02:16:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	278	2	2023	Select Counties in IA, MN, MT, NE, ND, SD	Select Counties in IA/NE	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	1	1			2	0	0	05/30/2022	2023.01	05/30/2022 09:31:32 AM Eastern Daylight Time	06/01/2022 09:38:03 AM Eastern Daylight Time				06/02/2022 10:15:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	278	3	2023	Select Counties in IA, MN, MT, NE, ND, SD	Select Counties in MT	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 10:32:18 AM Eastern Daylight Time	08/03/2022 05:36:42 PM Eastern Daylight Time	07/30/2022 07:52:28 AM Eastern Daylight Time			08/04/2022 03:48:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-279 (PPO)	01	04		1			H5216	279	0	2023	South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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		1	08/04/2022	2023.01	08/04/2022 06:48:10 PM Eastern Daylight Time	08/03/2022 05:37:09 PM Eastern Daylight Time	07/30/2022 07:52:54 AM Eastern Daylight Time			08/04/2022 07:47:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-280 (PPO)	01	04		1			H5216	280	1	2023	Select counties in Georgia and South Carolina	Select counties in Georgia	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 08:27:51 AM Eastern Daylight Time	08/03/2022 05:37:34 PM Eastern Daylight Time	07/30/2022 07:53:18 AM Eastern Daylight Time			08/04/2022 03:38:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-280 (PPO)	01	04		1			H5216	280	2	2023	Select counties in Georgia and South Carolina	South Carolina	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 09:16:12 AM Eastern Daylight Time	08/03/2022 04:22:42 PM Eastern Daylight Time	07/30/2022 07:53:44 AM Eastern Daylight Time			08/04/2022 02:08:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-281 (PPO)	01	04		1			H5216	281	0	2023	Clark and Nye Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/29/2022	2023.01	05/29/2022 02:48:01 PM Eastern Daylight Time	08/03/2022 04:20:34 PM Eastern Daylight Time	07/30/2022 07:54:08 AM Eastern Daylight Time			08/04/2022 11:50:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-283 (PPO)	01	04		1			H5216	283	0	2023	Select Counties in IL		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2022	2023.01	08/02/2022 10:11:36 AM Eastern Daylight Time	08/03/2022 05:36:17 PM Eastern Daylight Time	07/30/2022 07:54:34 AM Eastern Daylight Time			08/04/2022 03:38:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-284 (PPO)	01	04		1			H5216	284	0	2023	Select counties in Georgia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 12:41:15 PM Eastern Daylight Time	08/03/2022 04:45:34 PM Eastern Daylight Time	07/30/2022 07:54:58 AM Eastern Daylight Time			08/04/2022 12:19:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-285 (PPO)	01	04		1			H5216	285	0	2023	Ohio & N KY		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			2	0	0	05/29/2022	2023.01	05/29/2022 04:30:58 PM Eastern Daylight Time	07/18/2022 05:26:04 PM Eastern Daylight Time				07/20/2022 02:11:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	286	0	2023	Select counties in Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	5	1			1		1	08/01/2022	2023.01	08/01/2022 01:37:11 PM Eastern Daylight Time	08/03/2022 04:44:36 PM Eastern Daylight Time	07/30/2022 07:55:24 AM Eastern Daylight Time			08/04/2022 11:51:45 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-287 (PPO)	01	04		1			H5216	287	0	2023	Detroit		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/28/2022	2023.01	05/28/2022 10:14:08 AM Eastern Daylight Time	08/03/2022 03:54:31 PM Eastern Daylight Time	07/30/2022 07:55:48 AM Eastern Daylight Time			08/04/2022 02:54:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-288 (PPO)	01	04		1			H5216	288	0	2023	Select Counties in Connecticut		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 07:48:20 PM Eastern Daylight Time	08/03/2022 03:53:27 PM Eastern Daylight Time	07/30/2022 07:56:12 AM Eastern Daylight Time			08/04/2022 02:54:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-289 (PPO)	01	04		1			H5216	289	0	2023	Select Counties in Connecticut		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	2	1	1		0	05/28/2022	2023.01	05/28/2022 10:15:44 AM Eastern Daylight Time	08/03/2022 03:53:58 PM Eastern Daylight Time	07/30/2022 07:56:38 AM Eastern Daylight Time			08/04/2022 02:54:32 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	2023	Select Counties in Connecticut		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 11:05:48 AM Eastern Daylight Time	08/03/2022 03:50:51 PM Eastern Daylight Time	07/30/2022 07:57:04 AM Eastern Daylight Time			08/04/2022 02:54:32 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	2023	Maine		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 06:55:36 PM Eastern Daylight Time	08/03/2022 04:02:58 PM Eastern Daylight Time	07/30/2022 07:57:28 AM Eastern Daylight Time			08/04/2022 02:28:49 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	2023	Select Counties in Mississippi		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	08/17/2022	2023.01	08/17/2022 04:27:32 PM Eastern Daylight Time	08/03/2022 04:00:51 PM Eastern Daylight Time	07/30/2022 07:57:52 AM Eastern Daylight Time			08/17/2022 04:44:15 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-293 (PPO)	01	04		1			H5216	293	0	2023	Select Counties in ID		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	08/17/2022	2023.01	08/17/2022 04:29:31 PM Eastern Daylight Time	08/03/2022 04:01:18 PM Eastern Daylight Time	07/30/2022 07:58:18 AM Eastern Daylight Time			08/17/2022 04:44:15 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-294 (PPO)	01	04		1			H5216	294	0	2023	Select counties in OR		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 04:32:40 PM Eastern Daylight Time	08/03/2022 04:02:13 PM Eastern Daylight Time	07/30/2022 07:58:42 AM Eastern Daylight Time			08/04/2022 11:20:10 AM 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	2023	Select counties in Utah		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/21/2022	2023.01	07/21/2022 04:17:24 PM Eastern Daylight Time	08/03/2022 04:03:26 PM Eastern Daylight Time	07/30/2022 07:59:08 AM Eastern Daylight Time			08/04/2022 02:28:49 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	2023	Select Counties in Mississippi		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2022	2023.01	08/02/2022 11:55:49 AM Eastern Daylight Time	08/03/2022 04:03:53 PM Eastern Daylight Time	07/30/2022 07:59:34 AM Eastern Daylight Time			08/04/2022 02:28:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-300 (PPO)	01	04		1			H5216	300	0	2023	Select Counties in Mississippi		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1	1			2	0	0	05/29/2022	2023.01	05/29/2022 09:23:48 PM Eastern Daylight Time	06/01/2022 09:37:34 AM Eastern Daylight Time				06/02/2022 05:00:08 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	301	1	2023	Select counties in ID,OR, WA and UT	Select Counties in OR	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	1	1			2	0	0	05/29/2022	2023.01	05/29/2022 09:24:47 PM Eastern Daylight Time	06/01/2022 09:38:31 AM Eastern Daylight Time				06/02/2022 05:10:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	301	2	2023	Select counties in ID,OR, WA and UT	Select Counties in UT	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	1	1			2	0	0	05/29/2022	2023.01	05/29/2022 09:25:45 PM Eastern Daylight Time	06/01/2022 09:39:01 AM Eastern Daylight Time				06/02/2022 05:10:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	301	3	2023	Select counties in ID,OR, WA and UT	Select Counties in ID	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	1	1			2	0	0	05/29/2022	2023.01	05/29/2022 09:26:38 PM Eastern Daylight Time	06/01/2022 09:39:29 AM Eastern Daylight Time				06/02/2022 05:10:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	301	4	2023	Select counties in ID,OR, WA and UT	Select Counties in WA	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 12:22:24 PM Eastern Daylight Time	08/03/2022 04:22:12 PM Eastern Daylight Time	07/30/2022 07:59:58 AM Eastern Daylight Time			08/04/2022 02:08:14 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	2023	Select Counties in Nevada		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2022	2023.01	08/02/2022 12:56:46 PM Eastern Daylight Time	08/03/2022 04:15:19 PM Eastern Daylight Time	07/30/2022 08:00:24 AM Eastern Daylight Time			08/04/2022 11:50:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-303 (PPO)	01	04		1			H5216	303	0	2023	Duluth Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	304	0	1	04	01	H5216_304_0	5	1			1		1	08/04/2022	2023.01	08/04/2022 03:40:29 PM Eastern Daylight Time	08/03/2022 06:00:43 PM Eastern Daylight Time	07/30/2022 08:00:48 AM Eastern Daylight Time			08/04/2022 04:12:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-304 (PPO)	01	04		1			H5216	304	0	2023	Central Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	305	0	1	04	01	H5216_305_0	5	1			1		1	08/01/2022	2023.01	08/01/2022 01:52:30 PM Eastern Daylight Time	08/03/2022 04:51:02 PM Eastern Daylight Time	07/30/2022 08:01:14 AM Eastern Daylight Time			08/04/2022 11:51:45 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana USAA Honor with Rx (PPO)	01	04		1			H5216	305	0	2023	Detroit Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	306	0	1	04	01	H5216_306_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:57:25 PM Eastern Daylight Time	08/03/2022 04:53:38 PM Eastern Daylight Time	07/30/2022 08:01:40 AM Eastern Daylight Time			08/04/2022 11:51:45 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-306 (PPO)	01	04		1			H5216	306	0	2023	Michigan		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	307	0	1	04	01	H5216_307_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:32:21 PM Eastern Daylight Time	08/03/2022 04:49:43 PM Eastern Daylight Time	07/30/2022 08:02:04 AM Eastern Daylight Time			08/04/2022 12:42:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana USAA Honor with Rx (PPO)	01	04		1			H5216	307	0	2023	Select Counties in Indiana & Ohio		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	308	0	1	04	01	H5216_308_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 03:27:50 PM Eastern Daylight Time	08/03/2022 04:23:04 PM Eastern Daylight Time	07/30/2022 08:02:28 AM Eastern Daylight Time			08/04/2022 04:33:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-308 (PPO)	01	04		1			H5216	308	0	2023	Virginia and Delaware		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	309	0	1	04	01	H5216_309_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:34:09 PM Eastern Daylight Time	08/03/2022 04:52:20 PM Eastern Daylight Time	07/30/2022 08:02:54 AM Eastern Daylight Time			08/04/2022 12:42:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-309 (PPO)	01	04		1			H5216	309	0	2023	Select Counties in Indiana, Ohio, & N KY		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	310	0	1	04	01	H5216_310_0	3	1			1	0	0	07/21/2022	2023.01	07/21/2022 11:41:47 AM Eastern Daylight Time	07/18/2022 05:23:55 PM Eastern Daylight Time				07/22/2022 05:03:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	310	0	2023	Virginia, Maryland, Delaware		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	311	0	1	04	01	H5216_311_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 04:34:18 PM Eastern Daylight Time	08/03/2022 05:28:47 PM Eastern Daylight Time	07/30/2022 08:03:18 AM Eastern Daylight Time			08/04/2022 01:45:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-311 (PPO)	01	04		1			H5216	311	0	2023	Southeast Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	312	0	1	04	01	H5216_312_0	5	1			1		1	08/01/2022	2023.01	08/01/2022 03:26:00 PM Eastern Daylight Time	08/03/2022 04:22:32 PM Eastern Daylight Time	07/30/2022 08:03:42 AM Eastern Daylight Time			08/04/2022 04:33:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-312 (PPO)	01	04		1			H5216	312	0	2023	Virginia and Delaware		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	313	0	1	04	01	H5216_313_0	3	1			1		1	08/04/2022	2023.01	08/04/2022 11:07:23 AM Eastern Daylight Time	08/03/2022 04:25:38 PM Eastern Daylight Time	07/30/2022 08:04:08 AM Eastern Daylight Time			08/04/2022 02:13:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-313 (PPO)	01	04		1			H5216	313	0	2023	Kauai and Maui Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	314	0	1	04	01	H5216_314_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:02:50 PM Eastern Daylight Time	08/03/2022 04:27:36 PM Eastern Daylight Time	07/30/2022 08:04:32 AM Eastern Daylight Time			08/04/2022 02:13:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana USAA Honor with Rx (PPO)	01	04		1			H5216	314	0	2023	Oahu		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	315	0	1	04	01	H5216_315_0	1	1			2	0	0	05/29/2022	2023.01	05/29/2022 09:42:10 PM Eastern Daylight Time	06/01/2022 09:42:15 AM Eastern Daylight Time				06/02/2022 07:14:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	315	0	2023	Select Counties In ID,MT,OR,UT,WA,WY		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	316	1	1	04	01	H5216_316_1	3	1			1		1	07/13/2022	2023.01	07/13/2022 06:28:50 PM Eastern Daylight Time	08/03/2022 04:15:46 PM Eastern Daylight Time	07/30/2022 08:04:58 AM Eastern Daylight Time			08/04/2022 10:51:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-316 (PPO)	01	04		1			H5216	316	1	2023	Select Counties in Oklahoma	Select Counties in Oklahoma	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	316	2	1	04	01	H5216_316_2	3	1			1		1	05/30/2022	2023.01	05/30/2022 09:14:36 AM Eastern Daylight Time	08/03/2022 04:16:17 PM Eastern Daylight Time	07/30/2022 08:05:22 AM Eastern Daylight Time			08/04/2022 10:51:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-316 (PPO)	01	04		1			H5216	316	2	2023	Select Counties in Oklahoma	Select Counties in Oklahoma	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	316	3	1	04	01	H5216_316_3	3	1			1		1	05/30/2022	2023.01	05/30/2022 03:06:52 PM Eastern Daylight Time	08/03/2022 04:16:45 PM Eastern Daylight Time	07/30/2022 08:05:48 AM Eastern Daylight Time			08/04/2022 10:51:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-316 (PPO)	01	04		1			H5216	316	3	2023	Select Counties in Oklahoma	Select Counties in Oklahoma	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	317	0	1	04	01	H5216_317_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:38:19 PM Eastern Daylight Time	08/03/2022 05:02:57 PM Eastern Daylight Time	07/30/2022 08:06:12 AM Eastern Daylight Time			08/04/2022 04:46:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-317 (PPO)	01	04		1			H5216	317	0	2023	Kentucky and Southern Indiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	318	1	1	04	01	H5216_318_1	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:37:16 PM Eastern Daylight Time	08/03/2022 04:13:12 PM Eastern Daylight Time	07/30/2022 08:06:36 AM Eastern Daylight Time			08/04/2022 10:51:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-318 (PPO)	01	04		1			H5216	318	1	2023	Select Counties in Kansas, Missouri and Illinois	Select Counties in Missouri and Illinois	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	318	2	1	04	01	H5216_318_2	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:37:32 PM Eastern Daylight Time	08/03/2022 04:13:43 PM Eastern Daylight Time	07/30/2022 08:07:02 AM Eastern Daylight Time			08/04/2022 10:51:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-318 (PPO)	01	04		1			H5216	318	2	2023	Select Counties in Kansas, Missouri and Illinois	Select Counties in Kansas City, MO-KS	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	318	3	1	04	01	H5216_318_3	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:37:47 PM Eastern Daylight Time	08/03/2022 04:14:13 PM Eastern Daylight Time	07/30/2022 08:07:26 AM Eastern Daylight Time			08/04/2022 10:51:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-318 (PPO)	01	04		1			H5216	318	3	2023	Select Counties in Kansas, Missouri and Illinois	Select Counties in Wichita	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	319	0	1	04	01	H5216_319_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:39:23 PM Eastern Daylight Time	08/03/2022 05:03:43 PM Eastern Daylight Time	07/30/2022 08:07:50 AM Eastern Daylight Time			08/04/2022 04:46:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-319 (PPO)	01	04		1			H5216	319	0	2023	Southern New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	320	0	1	04	01	H5216_320_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:40:25 PM Eastern Daylight Time	08/03/2022 05:04:30 PM Eastern Daylight Time	07/30/2022 08:08:16 AM Eastern Daylight Time			08/04/2022 04:46:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-320 (PPO)	01	04		1			H5216	320	0	2023	Southern New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	321	0	1	04	01	H5216_321_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:33:13 PM Eastern Daylight Time	08/03/2022 04:21:00 PM Eastern Daylight Time	07/30/2022 08:08:40 AM Eastern Daylight Time			08/04/2022 12:45:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-321 (PPO)	01	04		1			H5216	321	0	2023	Huntsville		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	322	0	1	04	01	H5216_322_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:21:17 PM Eastern Daylight Time	08/03/2022 05:05:17 PM Eastern Daylight Time	07/30/2022 08:09:06 AM Eastern Daylight Time			08/04/2022 05:11:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-322 (PPO)	01	04		1			H5216	322	0	2023	Kentucky and Southern Indiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	323	0	1	04	01	H5216_323_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:38:04 PM Eastern Daylight Time	08/03/2022 04:11:12 PM Eastern Daylight Time	07/30/2022 08:09:30 AM Eastern Daylight Time			08/04/2022 10:51:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-323 (PPO)	01	04		1			H5216	323	0	2023	Select Counties in Oklahoma		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	324	0	1	04	01	H5216_324_0	3	1			1		1	07/07/2022	2023.01	07/07/2022 10:10:08 AM Eastern Daylight Time	08/03/2022 05:08:23 PM Eastern Daylight Time	07/30/2022 08:09:56 AM Eastern Daylight Time			08/04/2022 05:11:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-324 (PPO)	01	04		1			H5216	324	0	2023	Kentucky and Southern Indiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	325	0	1	04	01	H5216_325_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 11:17:58 AM Eastern Daylight Time	08/03/2022 04:05:17 PM Eastern Daylight Time	07/30/2022 08:10:20 AM Eastern Daylight Time			08/04/2022 03:16:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-325 (PPO)	01	04		1			H5216	325	0	2023	Select counties in Louisiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	326	0	1	04	01	H5216_326_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 11:45:40 AM Eastern Daylight Time	08/03/2022 04:05:45 PM Eastern Daylight Time	07/30/2022 08:10:46 AM Eastern Daylight Time			08/04/2022 03:16:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-326 (PPO)	01	04		1			H5216	326	0	2023	Select Counties in Louisiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	327	0	1	04	01	H5216_327_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 02:44:17 PM Eastern Daylight Time	08/03/2022 05:06:51 PM Eastern Daylight Time	07/30/2022 08:11:12 AM Eastern Daylight Time			08/04/2022 03:15:10 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-327 (PPO)	01	04		1			H5216	327	0	2023	West Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	328	0	1	04	01	H5216_328_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 02:48:58 PM Eastern Daylight Time	08/03/2022 05:07:37 PM Eastern Daylight Time	07/30/2022 08:11:36 AM Eastern Daylight Time			08/04/2022 03:15:10 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-328 (PPO)	01	04		1			H5216	328	0	2023	West Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	329	0	1	04	01	H5216_329_0	2	1			2	0	0	05/30/2022	2023.01	05/30/2022 09:19:40 AM Eastern Daylight Time	07/18/2022 05:22:27 PM Eastern Daylight Time				07/20/2022 01:48:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	329	0	2023	Select Counties in AR, IL, IA, MO, KS, NE and OK		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	330	0	1	04	01	H5216_330_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 11:48:18 AM Eastern Daylight Time	08/03/2022 04:06:12 PM Eastern Daylight Time	07/30/2022 08:12:00 AM Eastern Daylight Time			08/04/2022 03:16:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-330 (PPO D-SNP)	01	04		1			H5216	330	0	2023	Select Counties in Louisiana		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	331	0	1	04	01	H5216_331_0	3	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 09:20:27 AM Eastern Daylight Time	08/03/2022 04:10:41 PM Eastern Daylight Time	07/30/2022 08:12:26 AM Eastern Daylight Time			08/04/2022 10:51:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-331 (PPO D-SNP)	01	04		1			H5216	331	0	2023	Select Counties in Oklahoma		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	332	0	1	04	01	H5216_332_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 11:48:12 AM Eastern Daylight Time	08/03/2022 04:07:35 PM Eastern Daylight Time	07/30/2022 08:12:52 AM Eastern Daylight Time			08/04/2022 03:16:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-332 (PPO D-SNP)	01	04		1			H5216	332	0	2023	Select Counties in Louisana		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	333	0	1	04	01	H5216_333_0	3	1			1		1	05/29/2022	2023.01	05/29/2022 07:20:54 PM Eastern Daylight Time	08/03/2022 04:16:59 PM Eastern Daylight Time	07/30/2022 08:13:16 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-333 (PPO)	01	04		1			H5216	333	0	2023	Colorado		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	334	0	1	04	01	H5216_334_0	4	1		1	1		1	08/02/2022	2023.01	08/02/2022 11:53:45 AM Eastern Daylight Time	08/03/2022 04:07:07 PM Eastern Daylight Time	07/30/2022 08:13:40 AM Eastern Daylight Time			08/04/2022 02:42:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice - Diabetes and Heart (PPO C-SNP)	01	04		1			H5216	334	0	2023	Select Counites in Mississippi		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	335	0	1	04	01	H5216_335_0	3	1			1		1	05/29/2022	2023.01	05/29/2022 07:22:32 PM Eastern Daylight Time	08/03/2022 04:19:11 PM Eastern Daylight Time	07/30/2022 08:14:06 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-335 (PPO)	01	04		1			H5216	335	0	2023	Maricopa Pima Pinal		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	336	0	1	04	01	H5216_336_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:26:52 PM Eastern Daylight Time	08/03/2022 04:23:32 PM Eastern Daylight Time	07/30/2022 08:14:30 AM Eastern Daylight Time			08/04/2022 02:59:41 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-336 (PPO)	01	04		1			H5216	336	0	2023	Select Counties in North Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	337	1	1	04	01	H5216_337_1	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:52:02 PM Eastern Daylight Time	08/03/2022 04:11:40 PM Eastern Daylight Time	07/30/2022 08:14:56 AM Eastern Daylight Time			08/04/2022 11:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-337 (PPO)	01	04		1			H5216	337	1	2023	Select Counties in Arkansas and Oklahoma	Select Counties in Oklahoma	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	337	2	1	04	01	H5216_337_2	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:53:43 PM Eastern Daylight Time	08/03/2022 04:12:10 PM Eastern Daylight Time	07/30/2022 08:15:20 AM Eastern Daylight Time			08/04/2022 11:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-337 (PPO)	01	04		1			H5216	337	2	2023	Select Counties in Arkansas and Oklahoma	Select Counties in Tulsa	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	337	3	1	04	01	H5216_337_3	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:55:06 PM Eastern Daylight Time	08/03/2022 04:12:40 PM Eastern Daylight Time	07/30/2022 08:15:46 AM Eastern Daylight Time			08/04/2022 11:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-337 (PPO)	01	04		1			H5216	337	3	2023	Select Counties in Arkansas and Oklahoma	Arkansas	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	338	0	1	04	01	H5216_338_0	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:20:58 PM Eastern Daylight Time	08/03/2022 04:14:44 PM Eastern Daylight Time	07/30/2022 08:16:10 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana USAA Honor with Rx (PPO)	01	04		1			H5216	338	0	2023	Maricopa		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	339	0	1	04	01	H5216_339_0	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:21:26 PM Eastern Daylight Time	08/03/2022 04:18:07 PM Eastern Daylight Time	07/30/2022 08:16:34 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-339 (PPO)	01	04		1			H5216	339	0	2023	New Mexico		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	340	0	1	04	01	H5216_340_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:00:14 PM Eastern Daylight Time	08/03/2022 04:17:16 PM Eastern Daylight Time	07/30/2022 08:17:00 AM Eastern Daylight Time			08/04/2022 11:21:39 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-340 (PPO)	01	04		1			H5216	340	0	2023	Select Counties in Iowa and Nebraska		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	341	0	1	04	01	H5216_341_0	3	1			1		1	07/31/2022	2023.01	07/31/2022 01:22:15 PM Eastern Daylight Time	08/03/2022 04:15:54 PM Eastern Daylight Time	07/30/2022 08:17:24 AM Eastern Daylight Time			08/04/2022 03:24:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-341 (PPO)	01	04		1			H5216	341	0	2023	New Mexico		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	342	0	1	04	01	H5216_342_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:15:51 PM Eastern Daylight Time	08/03/2022 03:59:30 PM Eastern Daylight Time	07/30/2022 08:17:50 AM Eastern Daylight Time			08/04/2022 03:11:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-342 (PPO)	01	04		1			H5216	342	0	2023	Select Counties in New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	343	0	1	04	01	H5216_343_0	3	1			1	0	0	07/22/2022	2023.01	07/22/2022 05:37:59 PM Eastern Daylight Time	07/18/2022 05:22:59 PM Eastern Daylight Time				07/22/2022 05:39:40 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-343 (PPO)	01	04		1			H5216	343	0	2023	North Carolina Select		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	345	0	1	04	01	H5216_345_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 03:22:23 PM Eastern Daylight Time	08/03/2022 05:38:00 PM Eastern Daylight Time	07/30/2022 08:18:16 AM Eastern Daylight Time			08/04/2022 03:38:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-345 (PPO)	01	04		1			H5216	345	0	2023	Select counties in Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	346	0	1	04	01	H5216_346_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 04:05:27 PM Eastern Daylight Time	08/03/2022 05:44:36 PM Eastern Daylight Time	07/30/2022 08:18:40 AM Eastern Daylight Time			08/04/2022 03:38:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-346 (PPO)	01	04		1			H5216	346	0	2023	Select counties in South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	347	0	1	04	01	H5216_347_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 03:19:42 PM Eastern Daylight Time	08/03/2022 05:41:35 PM Eastern Daylight Time	07/30/2022 08:19:06 AM Eastern Daylight Time			08/04/2022 03:38:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-347 (PPO)	01	04		1			H5216	347	0	2023	Select counties in Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	348	0	1	04	01	H5216_348_0	1	1			2	0	0	06/02/2022	2023.01	06/02/2022 02:16:10 PM Eastern Daylight Time	06/01/2022 08:44:52 AM Eastern Daylight Time				06/03/2022 10:42:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	348	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	349	0	1	04	01	H5216_349_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 10:15:44 AM Eastern Daylight Time	08/03/2022 05:38:26 PM Eastern Daylight Time	07/30/2022 08:19:30 AM Eastern Daylight Time			08/04/2022 03:38:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-349 (PPO)	01	04		1			H5216	349	0	2023	Select counties in Georgia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	350	0	1	04	01	H5216_350_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:55:26 PM Eastern Daylight Time	08/03/2022 03:54:16 PM Eastern Daylight Time	07/30/2022 08:19:56 AM Eastern Daylight Time			08/04/2022 12:45:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-350 (PPO)	01	04		1			H5216	350	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	351	0	1	04	01	H5216_351_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:55:45 PM Eastern Daylight Time	08/03/2022 03:53:22 PM Eastern Daylight Time	07/30/2022 08:20:20 AM Eastern Daylight Time			08/04/2022 12:45:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana USAA Honor with Rx (PPO)	01	04		1			H5216	351	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	352	0	1	04	01	H5216_352_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 03:56:00 PM Eastern Daylight Time	08/03/2022 03:54:43 PM Eastern Daylight Time	07/30/2022 08:20:46 AM Eastern Daylight Time			08/04/2022 12:45:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-352 (PPO)	01	04		1			H5216	352	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	353	0	1	04	01	H5216_353_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 03:56:29 PM Eastern Daylight Time	08/03/2022 03:56:28 PM Eastern Daylight Time	07/30/2022 08:21:10 AM Eastern Daylight Time			08/04/2022 12:45:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-353 (PPO)	01	04		1			H5216	353	0	2023	El Paso County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	354	0	1	04	01	H5216_354_0	2	1			2	0	0	05/29/2022	2023.01	05/29/2022 06:32:12 PM Eastern Daylight Time	07/18/2022 05:43:09 PM Eastern Daylight Time				07/20/2022 01:42:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	354	0	2023	Select Counties in MN, ND, SD		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	355	0	1	04	01	H5216_355_0	2	1			2	0	0	07/13/2022	2023.01	07/13/2022 03:53:31 PM Eastern Daylight Time	07/18/2022 05:45:45 PM Eastern Daylight Time				07/20/2022 01:42:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	355	0	2023	Select Counties in IL, WI		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	356	0	1	04	01	H5216_356_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 12:48:29 PM Eastern Daylight Time	08/03/2022 04:28:40 PM Eastern Daylight Time	07/30/2022 08:21:36 AM Eastern Daylight Time			08/04/2022 11:04:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-356 (PPO)	01	04		1			H5216	356	0	2023	Madison area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	357	0	1	04	01	H5216_357_0	4	1			1		1	07/22/2022	2023.01	07/22/2022 05:34:10 PM Eastern Daylight Time	08/03/2022 04:27:41 PM Eastern Daylight Time	07/30/2022 08:22:00 AM Eastern Daylight Time			08/04/2022 11:31:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-357 (PPO)	01	04		1			H5216	357	0	2023	Chicago area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	358	0	1	04	01	H5216_358_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 04:09:40 PM Eastern Daylight Time	08/03/2022 03:53:49 PM Eastern Daylight Time	07/30/2022 08:22:26 AM Eastern Daylight Time			08/04/2022 01:21:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-358 (PPO)	01	04		1			H5216	358	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	359	0	1	04	01	H5216_359_0	3	1			1		1	05/28/2022	2023.01	05/28/2022 10:55:59 AM Eastern Daylight Time	08/03/2022 04:30:59 PM Eastern Daylight Time	07/30/2022 08:22:50 AM Eastern Daylight Time			08/04/2022 11:31:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-359 (PPO)	01	04		1			H5216	359	0	2023	Twin Cities, Rochester, Duluth Areas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	360	0	1	04	01	H5216_360_0	3	1			2		1	08/01/2022	2023.01	08/01/2022 04:09:59 PM Eastern Daylight Time	08/03/2022 03:55:10 PM Eastern Daylight Time	07/30/2022 08:23:14 AM Eastern Daylight Time			08/04/2022 01:09:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-360 (PPO)	01	04		1			H5216	360	0	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1						05/27/2022	2023.01	05/27/2022 12:12:29 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	805	0	2023	Select Counties in Multi-States		1	5776021	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:12:47 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	806	0	2023	Select Counties in Multi-States		1	191647	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:13:07 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5216	808	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:13:29 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5216	809	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:13:49 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	811	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:14:09 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	812	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:14:28 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	813	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:15:02 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	814	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:15:26 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	815	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:15:47 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	816	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:16:09 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	817	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:16:30 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	818	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	819	0	1	04	01	H5216_819_0	4	1						05/31/2022	2023.01	05/31/2022 09:26:48 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	819	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	820	0	1	04	01	H5216_820_0	4	1						05/31/2022	2023.01	05/31/2022 09:47:21 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	820	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	821	0	1	04	01	H5216_821_0	4	1						05/31/2022	2023.01	05/31/2022 09:44:28 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	821	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	822	0	1	04	01	H5216_822_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 09:44:46 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	822	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	823	0	1	04	01	H5216_823_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 09:45:05 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	823	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	824	0	1	04	01	H5216_824_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 09:47:07 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	824	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	8	1						08/03/2022	2023.01	08/03/2022 02:53:51 PM Eastern Daylight Time	08/05/2022 08:53:51 AM Eastern Daylight Time	08/05/2022 08:53:52 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Preferred PPO (PPO)	01	04		1			H5232	001	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 12:32:40 PM Central Daylight Time	08/03/2022 10:52:02 AM Central Daylight Time	07/31/2022 02:57:41 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus (HMO-POS)	01	02		1			H5253	004	0	2023	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	4	1		1	2		0	08/15/2022	2023.01	08/15/2022 11:09:57 AM Central Daylight Time	08/03/2022 10:52:40 AM Central Daylight Time	07/31/2022 02:58:06 AM Central Daylight Time			08/15/2022 04:46:12 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 12:35:35 PM Central Daylight Time	08/03/2022 10:53:19 AM Central Daylight Time	07/31/2022 02:58:31 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	011	0	2023	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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 03:06:54 PM Central Daylight Time	06/01/2022 11:14:36 AM Central Daylight Time				06/03/2022 02:28:22 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	2023	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	02	01	H5253_024_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:24:11 PM Central Daylight Time	08/03/2022 10:54:01 AM Central Daylight Time	07/31/2022 02:58:56 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO-POS D-SNP)	01	02		1			H5253	024	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 12:36:50 PM Central Daylight Time	08/03/2022 10:54:38 AM Central Daylight Time	07/31/2022 02:59:21 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	030	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 12:37:39 PM Central Daylight Time	08/03/2022 10:55:16 AM Central Daylight Time	07/31/2022 02:59:45 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Premier Value (HMO-POS)	01	02		1			H5253	033	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 12:40:15 PM Central Daylight Time	08/03/2022 10:55:55 AM Central Daylight Time	07/31/2022 03:00:10 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	01	02		1			H5253	034	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:55:40 AM Central Daylight Time	08/03/2022 10:56:32 AM Central Daylight Time	07/31/2022 03:00:35 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus (HMO-POS)	01	02		1			H5253	035	0	2023	Graham, Pima, and Santa Cruz 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			
H5253	036	0	1	02	01	H5253_036_0	2	1			2		1	05/31/2022	2023.01	05/31/2022 11:06:42 PM Central Daylight Time	08/03/2022 10:57:11 AM Central Daylight Time	07/31/2022 03:00:59 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	036	0	2023	Yavapai county		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			
H5253	037	0	1	02	01	H5253_037_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:41:08 AM Central Daylight Time	08/03/2022 10:57:55 AM Central Daylight Time	07/31/2022 03:01:24 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 12:45:45 PM Central Daylight Time	08/03/2022 10:58:33 AM Central Daylight Time	07/31/2022 03:01:49 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:43:48 AM Central Daylight Time	08/03/2022 10:59:12 AM Central Daylight Time	07/31/2022 03:02:13 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 12:08:24 PM Central Daylight Time	06/01/2022 11:21:20 AM Central Daylight Time				06/02/2022 01:42:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H5253	040	0	2023	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	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:40:11 PM Central Daylight Time	08/03/2022 10:59:50 AM Central Daylight Time	07/31/2022 03:02:39 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	5	1		1	2		0	08/15/2022	2023.01	08/15/2022 11:10:05 AM Central Daylight Time	08/03/2022 11:00:32 AM Central Daylight Time	07/31/2022 03:03:04 AM Central Daylight Time			08/15/2022 04:46:12 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	2023	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	08/15/2022	2023.01	08/15/2022 11:10:14 AM Central Daylight Time	08/03/2022 11:01:12 AM Central Daylight Time	07/31/2022 03:03:29 AM Central Daylight Time			08/15/2022 04:46:12 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	2023	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	02	01	H5253_047_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:01:41 PM Central Daylight Time	08/03/2022 11:01:51 AM Central Daylight Time	07/31/2022 03:03:53 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	047	0	2023	Select Counties in Tennessee and Virginia		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	048	0	1	02	01	H5253_048_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:02:13 PM Central Daylight Time	08/03/2022 11:02:30 AM Central Daylight Time	07/31/2022 03:04:18 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	048	0	2023	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	02	01	H5253_049_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 11:22:13 AM Central Daylight Time	08/03/2022 11:03:08 AM Central Daylight Time	07/31/2022 03:04:43 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 7 (HMO-POS)	01	02		1			H5253	049	0	2023	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	02	01	H5253_050_0	2	1			2		1	08/04/2022	2023.01	08/04/2022 10:37:30 AM Central Daylight Time	08/03/2022 11:03:47 AM Central Daylight Time	07/31/2022 03:05:07 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	050	0	2023	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	2			
H5253	051	0	1	02	01	H5253_051_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 11:25:36 AM Central Daylight Time	08/03/2022 11:04:25 AM Central Daylight Time	07/31/2022 03:05:32 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO-POS)	01	02		1			H5253	051	0	2023	Select counties in Ohio and Kentucky		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	052	0	1	02	01	H5253_052_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 11:30:42 AM Central Daylight Time	08/03/2022 11:05:03 AM Central Daylight Time	07/31/2022 03:05:57 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 6 (HMO-POS)	01	02		1			H5253	052	0	2023	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	02	01	H5253_059_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 01:55:38 PM Central Daylight Time	08/03/2022 11:05:41 AM Central Daylight Time	07/31/2022 03:06:22 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO-POS D-SNP)	01	02		1			H5253	059	0	2023	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	5	1		1	2		0	08/15/2022	2023.01	08/15/2022 11:10:22 AM Central Daylight Time	08/03/2022 11:06:19 AM Central Daylight Time	07/31/2022 03:06:47 AM Central Daylight Time			08/15/2022 04:46:12 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	2023	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	08/15/2022	2023.01	08/15/2022 11:10:31 AM Central Daylight Time	08/03/2022 11:07:00 AM Central Daylight Time	07/31/2022 03:07:12 AM Central Daylight Time			08/15/2022 04:46:12 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	2023	Lake County 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	2			
H5253	062	0	1	02	01	H5253_062_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 11:36:39 AM Central Daylight Time	08/03/2022 11:07:40 AM Central Daylight Time	07/31/2022 03:07:36 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 5 (HMO-POS)	01	02		1			H5253	062	0	2023	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	08/15/2022	2023.01	08/15/2022 11:10:40 AM Central Daylight Time	08/03/2022 11:08:19 AM Central Daylight Time	07/31/2022 03:08:01 AM Central Daylight Time			08/15/2022 04:46:12 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 12:42:29 PM Central Daylight Time	08/03/2022 11:08:57 AM Central Daylight Time	07/31/2022 03:08:26 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	01	02		1			H5253	072	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:38:46 PM Central Daylight Time	08/03/2022 11:09:36 AM Central Daylight Time	07/31/2022 03:08:50 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	073	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 12:49:12 PM Central Daylight Time	08/03/2022 11:10:15 AM Central Daylight Time	07/31/2022 03:09:15 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 12:50:27 PM Central Daylight Time	08/03/2022 11:10:53 AM Central Daylight Time	07/31/2022 03:09:40 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	02	01	H5253_081_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:03:17 PM Central Daylight Time	08/03/2022 11:11:31 AM Central Daylight Time	07/31/2022 03:10:04 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	081	0	2023	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	02	01	H5253_082_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:05:07 PM Central Daylight Time	08/03/2022 11:12:10 AM Central Daylight Time	07/31/2022 03:10:29 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	082	0	2023	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	02	01	H5253_083_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:06:42 PM Central Daylight Time	08/03/2022 11:12:48 AM Central Daylight Time	07/31/2022 03:10:54 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	083	0	2023	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	02	01	H5253_084_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:07:49 PM Central Daylight Time	08/03/2022 11:13:27 AM Central Daylight Time	07/31/2022 03:11:18 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	084	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:46:59 AM Central Daylight Time	08/03/2022 11:14:05 AM Central Daylight Time	07/31/2022 03:11:43 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 1 (HMO-POS)	01	02		1			H5253	087	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 05:02:45 PM Central Daylight Time	08/03/2022 11:14:44 AM Central Daylight Time	07/31/2022 03:12:07 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 2 (HMO-POS)	01	02		1			H5253	088	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 05:03:25 PM Central Daylight Time	08/03/2022 11:15:22 AM Central Daylight Time	07/31/2022 03:12:32 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	089	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:39:38 PM Central Daylight Time	08/03/2022 11:16:01 AM Central Daylight Time	07/31/2022 03:12:57 AM Central Daylight Time			08/04/2022 04:41:28 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	01	02		1			H5253	097	0	2023	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	02	01	H5253_099_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 11:37:09 AM Central Daylight Time	08/03/2022 11:16:39 AM Central Daylight Time	07/31/2022 03:13:21 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 1 (HMO-POS)	01	02		1			H5253	099	0	2023	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	02	01	H5253_100_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 11:37:44 AM Central Daylight Time	08/03/2022 11:17:18 AM Central Daylight Time	07/31/2022 03:13:47 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 2 (HMO-POS)	01	02		1			H5253	100	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:00:54 PM Central Daylight Time	08/03/2022 11:17:56 AM Central Daylight Time	07/31/2022 03:14:11 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:50:08 AM Central Daylight Time	08/03/2022 11:18:35 AM Central Daylight Time	07/31/2022 03:14:36 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:50:30 AM Central Daylight Time	08/03/2022 11:19:13 AM Central Daylight Time	07/31/2022 03:15:01 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:02:20 PM Central Daylight Time	08/03/2022 11:19:51 AM Central Daylight Time	07/31/2022 03:15:26 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H5253	105	0	2023	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	107	1	1	02	01	H5253_107_1	4	1			2		1	08/05/2022	2023.01	08/05/2022 10:59:06 AM Central Daylight Time	08/03/2022 11:20:30 AM Central Daylight Time	07/31/2022 03:15:50 AM Central Daylight Time			08/05/2022 11:55:43 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	2023	Select Counties in Iowa and Illinois	Des Moines Metro 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					2	2			
H5253	107	2	1	02	01	H5253_107_2	4	1			2		1	08/05/2022	2023.01	08/05/2022 10:59:15 AM Central Daylight Time	08/03/2022 11:21:08 AM Central Daylight Time	07/31/2022 03:16:15 AM Central Daylight Time			08/05/2022 11:55:43 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	2023	Select Counties in Iowa and Illinois	Select Counties in Iowa and Illinois	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	2			
H5253	108	1	1	02	01	H5253_108_1	5	1			2		1	08/05/2022	2023.01	08/05/2022 10:59:23 AM Central Daylight Time	08/03/2022 11:21:47 AM Central Daylight Time	07/31/2022 03:16:39 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	108	1	2023	Select Counties in Iowa and Illinois	Northwestern Illinois	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	2			
H5253	108	2	1	02	01	H5253_108_2	4	1			2		1	08/05/2022	2023.01	08/05/2022 10:59:31 AM Central Daylight Time	08/03/2022 11:22:25 AM Central Daylight Time	07/31/2022 03:17:04 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	108	2	2023	Select Counties in Iowa and Illinois	Select Counties in Iowa and Illinois	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	2			
H5253	108	3	1	02	01	H5253_108_3	4	1			2		1	08/05/2022	2023.01	08/05/2022 10:59:40 AM Central Daylight Time	08/03/2022 11:23:03 AM Central Daylight Time	07/31/2022 03:17:29 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	108	3	2023	Select Counties in Iowa and Illinois	Des Moines Metro 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					2	2			
H5253	109	1	1	02	01	H5253_109_1	2	1			2		1	08/03/2022	2023.01	08/03/2022 11:43:14 AM Central Daylight Time	08/03/2022 11:23:41 AM Central Daylight Time	07/31/2022 03:17:53 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	109	1	2023	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	02	01	H5253_109_2	2	1			2		1	08/03/2022	2023.01	08/03/2022 11:43:55 AM Central Daylight Time	08/03/2022 11:24:20 AM Central Daylight Time	07/31/2022 03:18:18 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	109	2	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:05:03 PM Central Daylight Time	08/03/2022 11:24:58 AM Central Daylight Time	07/31/2022 03:18:43 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H5253	110	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:52:02 AM Central Daylight Time	08/03/2022 11:25:40 AM Central Daylight Time	07/31/2022 03:19:07 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:52:25 AM Central Daylight Time	08/03/2022 11:26:19 AM Central Daylight Time	07/31/2022 03:19:32 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 05:04:06 PM Central Daylight Time	08/03/2022 11:26:58 AM Central Daylight Time	07/31/2022 03:19:57 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 05:04:22 PM Central Daylight Time	08/03/2022 11:27:37 AM Central Daylight Time	07/31/2022 03:20:22 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	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	02	01	H5253_113_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 04:17:09 PM Central Daylight Time	06/01/2022 11:51:57 AM Central Daylight Time				06/03/2022 11:22:19 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H5253	113	0	2023	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	02	01	H5253_115_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 11:44:25 AM Central Daylight Time	08/03/2022 11:28:15 AM Central Daylight Time	07/31/2022 03:20:47 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Flex Plan 8 (HMO-POS)	01	02		1			H5253	115	0	2023	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	116	0	1	02	01	H5253_116_0	3	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 08:47:41 AM Central Daylight Time	08/03/2022 11:28:54 AM Central Daylight Time	07/31/2022 03:21:12 AM Central Daylight Time			08/12/2022 10:01:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H5253	116	0	2023	Select counties of 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	117	0	1	02	01	H5253_117_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 01:09:48 PM Central Daylight Time	08/03/2022 11:29:32 AM Central Daylight Time	07/31/2022 03:21:37 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO-POS)	01	02		1			H5253	117	0	2023	Select counties of 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	118	0	1	02	01	H5253_118_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 10:57:12 AM Central Daylight Time	08/03/2022 11:30:10 AM Central Daylight Time	07/31/2022 03:22:02 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H5253	118	0	2023	Select counties in Virginia		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	119	0	1	02	01	H5253_119_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 10:57:32 AM Central Daylight Time	08/03/2022 11:30:48 AM Central Daylight Time	07/31/2022 03:22:26 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H5253	119	0	2023	Select counties in Virginia		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	120	0	1	02	01	H5253_120_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 10:57:49 AM Central Daylight Time	08/03/2022 11:31:26 AM Central Daylight Time	07/31/2022 03:22:51 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H5253	120	0	2023	Select counties in Virginia		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	121	0	1	02	01	H5253_121_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:13:01 PM Central Daylight Time	08/03/2022 11:32:05 AM Central Daylight Time	07/31/2022 03:23:15 AM Central Daylight Time			08/04/2022 04:14:08 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Rebate (HMO-POS)	01	02		1			H5253	121	0	2023	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	122	0	1	02	01	H5253_122_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 11:49:27 AM Central Daylight Time	08/03/2022 11:32:43 AM Central Daylight Time	07/31/2022 03:23:41 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H5253	122	0	2023	Select counties in Ohio		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	801	0	1	01	01	H5253_801_0	1	1						06/03/2022	2023.01	06/03/2022 10:43:39 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	801	0	2023	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	06/03/2022	2023.01	06/03/2022 10:43:54 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	802	0	2023	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						06/03/2022	2023.01	06/03/2022 10:44:06 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	805	0	2023	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						06/03/2022	2023.01	06/03/2022 10:44:19 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	810	0	2023	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						06/03/2022	2023.01	06/03/2022 10:44:30 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	811	0	2023	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	06/03/2022	2023.01	06/03/2022 10:44:43 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	812	0	2023	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						06/03/2022	2023.01	06/03/2022 10:45:00 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	813	0	2023	Select counties in North Carolina		1	3324	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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						06/03/2022	2023.01	06/03/2022 10:45:13 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	814	0	2023	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	06/03/2022	2023.01	06/03/2022 10:45:25 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	815	0	2023	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						06/03/2022	2023.01	06/03/2022 10:45:38 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H5253	816	0	2023	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						06/03/2022	2023.01	06/03/2022 10:45:51 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H5253	817	0	2023	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						06/03/2022	2023.01	06/03/2022 10:46:03 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	818	0	2023	Select counties in IA, IL, TN, & VA		1	3588	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	06/03/2022	2023.01	06/03/2022 10:46:26 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	819	0	2023	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						06/03/2022	2023.01	06/03/2022 10:46:38 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	820	0	2023	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						06/03/2022	2023.01	06/03/2022 10:46:49 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	821	0	2023	Select counties in Kentucky and Ohio		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		(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	06/03/2022	2023.01	06/03/2022 10:47:00 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	822	0	2023	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						06/03/2022	2023.01	06/03/2022 10:47:11 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	823	0	2023	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						06/03/2022	2023.01	06/03/2022 10:47:22 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	824	0	2023	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	06/03/2022	2023.01	06/03/2022 10:47:34 AM Eastern Daylight Time					06/03/2022 03:34:43 PM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	825	0	2023	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	2	2				0	0	06/01/2022	2023.01	06/01/2022 02:17:13 PM Central Daylight Time					06/03/2022 08:10:31 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	2023	Grant, Crawford, Iowa, Lafayette Counties		2	36792	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	2	2				0	0	06/02/2022	2023.01	06/02/2022 09:53:53 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	Grant, Crawford, Iowa, Lafayette Counties		2	4359	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	2	2				0	0	06/02/2022	2023.01	06/02/2022 10:20:19 AM Central Daylight Time					06/03/2022 08:10:31 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	2023	Grant, Crawford, Iowa, Lafayette Counties		2	6300	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:09:30 AM Central Daylight Time	08/05/2022 04:23:35 PM Central Daylight Time	08/05/2022 04:23:39 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:19:18 AM Central Daylight Time	08/05/2022 04:47:53 PM Central Daylight Time	08/05/2022 04:47:53 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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	08/05/2022	2023.01	08/05/2022 11:21:38 AM Central Daylight Time	06/04/2022 06:17:04 AM Central Daylight Time				08/05/2022 02:56:06 PM 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	2023	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	08/05/2022	2023.01	08/05/2022 11:14:29 AM Central Daylight Time	06/04/2022 06:17:04 AM Central Daylight Time				08/05/2022 02:56:06 PM 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	2023	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	08/05/2022	2023.01	08/05/2022 11:32:06 AM Central Daylight Time	08/05/2022 04:47:54 PM Central Daylight Time	08/05/2022 04:47:54 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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	08/05/2022	2023.01	08/05/2022 11:34:31 AM Central Daylight Time	08/05/2022 04:23:35 PM Central Daylight Time	08/05/2022 04:23:40 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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	3	1				0	0	08/05/2022	2023.01	08/05/2022 11:35:40 AM Central Daylight Time	06/04/2022 06:17:05 AM Central Daylight Time				08/05/2022 02:56:06 PM 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	2023	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	3	1				0	0	08/05/2022	2023.01	08/05/2022 11:33:17 AM Central Daylight Time	06/04/2022 06:17:05 AM Central Daylight Time				08/05/2022 02:56:06 PM 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	2023	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	2	1					1	07/06/2022	2023.01	07/06/2022 02:07:57 PM Central Daylight Time	06/04/2022 06:17:05 AM Central Daylight Time	06/04/2022 06:17:09 AM Central Daylight Time			07/07/2022 08:51:40 AM 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	2023	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	08/05/2022	2023.01	08/05/2022 11:38:21 AM Central Daylight Time	08/05/2022 04:23:35 PM Central Daylight Time	08/05/2022 04:23:40 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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	07/06/2022	2023.01	07/06/2022 02:22:47 PM Central Daylight Time	06/04/2022 06:17:05 AM Central Daylight Time				07/07/2022 08:51:40 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	2023	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	2	1					1	07/06/2022	2023.01	07/06/2022 02:31:22 PM Central Daylight Time	06/04/2022 06:17:06 AM Central Daylight Time	06/04/2022 06:17:10 AM Central Daylight Time			07/07/2022 08:51:40 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health IL Quartz Med Advantage Value D(w/Rx) (HMO)	01	01		1			H5262	018	0	2023	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	08/05/2022	2023.01	08/05/2022 11:38:58 AM Central Daylight Time	08/05/2022 04:23:36 PM Central Daylight Time	08/05/2022 04:23:41 PM Central Daylight Time			08/05/2022 04:53:50 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health IL Quartz Med Advantage Core D (w/Rx) (HMO)	01	01		1			H5262	019	0	2023	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	07/06/2022	2023.01	07/06/2022 02:50:45 PM Central Daylight Time	06/04/2022 06:17:06 AM Central Daylight Time				07/07/2022 08:51:40 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health IL Quartz Med Advantage Value (HMO)	01	01		1			H5262	020	0	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:27:33 AM Central Daylight Time	08/05/2022 04:23:36 PM Central Daylight Time	08/05/2022 04:23:41 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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	08/05/2022	2023.01	08/05/2022 11:36:56 AM Central Daylight Time	08/05/2022 04:23:36 PM Central Daylight Time	08/05/2022 04:23:41 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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	07/06/2022	2023.01	07/06/2022 03:10:16 PM Central Daylight Time	06/06/2022 12:54:43 PM Central Daylight Time	06/04/2022 06:17:10 AM Central Daylight Time			07/07/2022 08:51:40 AM 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	2023	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	3	1				0	0	07/06/2022	2023.01	07/06/2022 03:14:23 PM Central Daylight Time	06/06/2022 12:54:43 PM Central Daylight Time				07/07/2022 08:51:40 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	2023	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	07/06/2022	2023.01	07/06/2022 03:24:46 PM Central Daylight Time	06/06/2022 12:54:43 PM Central Daylight Time	06/04/2022 06:17:10 AM Central Daylight Time			07/07/2022 08:51:40 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health IL Quartz Med Advantage Elite D(w/Rx) (HMO)	01	01		1			H5262	026	0	2023	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	3	1				0	0	07/06/2022	2023.01	07/06/2022 03:27:43 PM Central Daylight Time	06/06/2022 12:54:43 PM Central Daylight Time				07/07/2022 08:51:40 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health IL Quartz Med Advantage Elite (HMO)	01	01		1			H5262	027	0	2023	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	029	0	1	01	01	H5262_029_0	4	1	2	1			0	08/05/2022	2023.01	08/05/2022 11:41:22 AM Central Daylight Time	08/05/2022 04:23:37 PM Central Daylight Time	08/05/2022 04:23:42 PM Central Daylight Time			08/05/2022 04:53:50 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP)	01	01		1			H5262	029	0	2023	La Crosse County		2		2			1	3		2					1	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	030	0	1	01	01	H5262_030_0	4	1	2	1			0	08/05/2022	2023.01	08/05/2022 11:42:46 AM Central Daylight Time	08/05/2022 04:23:37 PM Central Daylight Time	08/05/2022 04:23:42 PM Central Daylight Time			08/05/2022 04:53:50 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP)	01	01		1			H5262	030	0	2023	Dane County		2		2			1	3		2					1	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	031	0	1	01	01	H5262_031_0	4	1	2	1			0	08/05/2022	2023.01	08/05/2022 11:43:27 AM Central Daylight Time	08/05/2022 04:23:38 PM Central Daylight Time	08/05/2022 04:23:42 PM Central Daylight Time			08/05/2022 04:53:50 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Aurora Health Quartz Med Advantage Dual Eligible (HMO D-SNP)	01	01		1			H5262	031	0	2023	Milwuakee County		2		2			1	3		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	801	0	1	01	01	H5262_801_0	1	1						05/18/2022	2023.01	05/18/2022 08:26:12 AM Central Daylight Time					06/04/2022 06:57:24 AM 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	2023	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	2		2		1					1				
H5262	802	0	1	01	01	H5262_802_0	1	1				0	0	05/18/2022	2023.01	05/18/2022 08:26:49 AM Central Daylight Time					06/04/2022 06:57:24 AM 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	2023	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	2		2		1					1				
H5264	002	0	1	18	06	H5264_002_0	4	2				0	0	07/18/2022	2023.01	07/18/2022 01:12:31 PM Central Daylight Time					07/18/2022 03:20:59 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	2023	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	005	0	1	18	06	H5264_005_0	4	2				0	0	07/18/2022	2023.01	07/18/2022 01:14:17 PM Central Daylight Time					07/18/2022 03:20:59 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	2023	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	6	1					1	08/03/2022	2023.01	08/03/2022 02:18:08 PM Eastern Daylight Time	08/03/2022 10:35:20 AM Eastern Daylight Time	08/02/2022 02:20:36 PM Eastern Daylight Time			08/05/2022 12:05:01 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	2023	Most of Connecticut		2		2			2									www.carepartnersct.com/carepartners-connecticut-doctor-search	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	6	1					1	08/03/2022	2023.01	08/03/2022 02:18:58 PM Eastern Daylight Time	08/03/2022 10:35:44 AM Eastern Daylight Time	08/02/2022 02:20:56 PM Eastern Daylight Time			08/05/2022 12:05:01 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	2023	Most of Connecticut		2		2			2									www.carepartnersct.com/carepartners-connecticut-doctor-search	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	801	0	1	01	01	H5273_801_0	2	1						06/06/2022	2023.01	06/06/2022 08:28:47 PM Eastern Daylight Time					07/19/2022 06:30:50 PM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CarePartners of CT CareAdvantage (HMO)	01	01		1			H5273	801	0	2023	Most of Connecticut		1	79134	2			2									www.carepartnersct.com/carepartners-connecticut-doctor-search	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	802	0	1	01	01	H5273_802_0	2	1						06/06/2022	2023.01	06/06/2022 08:33:28 PM Eastern Daylight Time					07/19/2022 06:30:50 PM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CarePartners of CT CareAdvantage (HMO)	01	01		1			H5273	802	0	2023	Most of Connecticut		1	79134	2			2									www.carepartnersct.com/carepartners-connecticut-doctor-search	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	1	1						06/01/2022	2023.01	06/01/2022 07:57:19 PM Pacific Daylight Time					06/05/2022 06:47:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/duals	Molina Dual Options MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H5280	001	0	2023	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	6	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 09:02:17 PM Pacific Daylight Time	08/03/2022 08:25:27 PM Eastern Daylight Time	07/30/2022 09:33:01 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Dual Liberty Nurture (HMO D-SNP)	01	01		1			H5294	010	0	2023	Select counties in TX		2		2			1	3		1					1	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(877)935-8023		(877)935-8023		(844)917-0175		(844)917-0175		(877)935-8023		(877)935-8023		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	011	0	1	01	01	H5294_011_0	4	1						08/01/2022	2023.01	08/01/2022 10:44:57 PM Eastern Daylight Time	08/03/2022 08:26:25 PM Eastern Daylight Time	07/30/2022 09:33:32 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare No Premium (HMO)	01	01		1			H5294	011	0	2023	Select counties in TX		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	012	0	1	01	01	H5294_012_0	4	1						08/03/2022	2023.01	08/03/2022 02:46:24 PM Eastern Daylight Time	08/03/2022 08:27:23 PM Eastern Daylight Time	07/30/2022 09:34:04 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Giveback (HMO)	01	01		1			H5294	012	0	2023	Select counties in TX		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	013	0	1	01	01	H5294_013_0	4	1						07/13/2022	2023.01	07/13/2022 09:05:05 PM Pacific Daylight Time	08/03/2022 08:28:20 PM Eastern Daylight Time	07/30/2022 09:34:35 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Complement Assist (HMO)	01	01		1			H5294	013	0	2023	Select counties in TX		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(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	05/26/2022	2023.01	05/26/2022 04:02:49 PM Pacific Daylight Time	06/03/2022 08:39:10 PM Eastern Daylight Time				07/15/2022 04:06:59 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Patriot No Premium (HMO)	01	01		1			H5294	014	0	2023	Select counties in TX		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5294	015	0	1	01	01	H5294_015_0	7	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 09:07:28 PM Pacific Daylight Time	08/03/2022 08:29:19 PM Eastern Daylight Time	07/30/2022 09:35:07 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Dual Access Harmony (HMO D-SNP)	01	01		1			H5294	015	0	2023	Select counties in TX		2		2			1	3		1					1	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(877)935-8023		(877)935-8023		(844)917-0175		(844)917-0175		(877)935-8023		(877)935-8023		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	016	0	1	01	01	H5294_016_0	4	1						07/13/2022	2023.01	07/13/2022 09:10:12 PM Pacific Daylight Time	08/03/2022 08:30:19 PM Eastern Daylight Time	07/30/2022 09:35:38 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Complement Assist (HMO)	01	01		1			H5294	016	0	2023	Select counties in TX		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	017	0	1	01	01	H5294_017_0	4	1						08/01/2022	2023.01	08/01/2022 10:49:38 PM Eastern Daylight Time	08/03/2022 08:31:18 PM Eastern Daylight Time	07/30/2022 09:36:09 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare No Premium (HMO)	01	01		1			H5294	017	0	2023	Select counties in TX		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	018	0	1	01	01	H5294_018_0	4	1						08/01/2022	2023.01	08/01/2022 10:52:03 PM Eastern Daylight Time	08/03/2022 08:32:23 PM Eastern Daylight Time	07/30/2022 09:36:41 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare No Premium (HMO)	01	01		1			H5294	018	0	2023	Select counties in TX		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	019	0	1	01	01	H5294_019_0	4	1						08/03/2022	2023.01	08/03/2022 02:47:26 PM Eastern Daylight Time	08/03/2022 08:33:27 PM Eastern Daylight Time	07/30/2022 09:37:12 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Giveback (HMO)	01	01		1			H5294	019	0	2023	Select counties in TX		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	020	0	1	01	01	H5294_020_0	5	1						08/01/2022	2023.01	08/01/2022 10:58:18 PM Eastern Daylight Time	08/04/2022 09:49:33 AM Eastern Daylight Time	07/30/2022 09:37:43 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare No Premium (HMO)	01	01		1			H5294	020	0	2023	Select Counties in Texas		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(844)796-6811		(844)796-6811		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	801	0	1	01	01	H5294_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:17:01 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/medicare	Wellcare Group Medicare Advantage (HMO)	01	01		1			H5294	801	0	2023	Select Counties in Texas		1	100	2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5294	802	0	1	01	01	H5294_802_0	1	1						05/10/2022	2023.01	05/10/2022 11:17:05 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/medicare	Wellcare Group Medicare Advantage (HMO)	01	01		1			H5294	802	0	2023	Select Counties in Texas		1	100	2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5294	803	0	1	01	01	H5294_803_0	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:17:10 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/medicare	Wellcare Group Medicare Advantage (HMO)	01	01		1			H5294	803	0	2023	Select Counties in Texas		1	100	2			2									www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5296	003	0	1	02	01	H5296_003_0	6	1					0	08/05/2022	2023.01	08/05/2022 02:22:03 PM Pacific Daylight Time	08/05/2022 02:17:51 PM Pacific Daylight Time	08/02/2022 10:53:32 AM Pacific Daylight Time			08/05/2022 03:03:37 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Platinum (HMO-POS)	01	02		1			H5296	003	0	2023	Mountains and Piedmont Regions		2		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	07/20/2022	2023.01	07/20/2022 01:05:51 PM Pacific Daylight Time	08/05/2022 02:17:43 PM Pacific Daylight Time	08/02/2022 10:57:06 AM Pacific Daylight Time			08/05/2022 03:03:37 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health NC Duals (HMO D-SNP)	01	01		1			H5296	004	0	2023	Mountains and Piedmont Regions		2		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	005	0	1	01	01	H5296_005_0	5	1		1			0	08/05/2022	2023.01	08/05/2022 02:22:21 PM Pacific Daylight Time	08/05/2022 02:17:44 PM Pacific Daylight Time	08/02/2022 02:26:24 PM Pacific Daylight Time			08/05/2022 03:03:37 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	alignmenthealthplan.com	Alignment Health Heart & Diabetes (HMO C-SNP)	01	01		1			H5296	005	0	2023	Mountains and Piedmont Regions		2		2			1	4			00000000000000000010000					www.alignmenthealthplan.com	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	2	1						06/03/2022	2023.01	06/03/2022 12:43:36 PM Pacific Daylight Time					06/06/2022 05:39:53 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	2023	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	2	1						06/04/2022	2023.01	06/04/2022 11:37:52 AM Pacific Daylight Time					06/06/2022 05:39:53 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	2023	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	06/04/2022	2023.01	06/04/2022 11:42:25 AM Pacific Daylight Time					06/06/2022 05:52:06 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	2023	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	2	1				0	0	06/04/2022	2023.01	06/04/2022 11:45:21 AM Pacific Daylight Time					06/06/2022 05:39:53 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	2023	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			
H5299	001	0	1	01	01	H5299_001_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:11:34 PM US Eastern Daylight Time	08/04/2022 09:48:08 AM Eastern Daylight Time	07/31/2022 01:50:38 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Devoted Health	www.Devoted.com	Devoted CORE North Carolina (HMO)	01	01		1			H5299	001	0	2023	Greensboro and Winston-Salem		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			
H5299	002	0	1	01	01	H5299_002_0	11	1					0	08/03/2022	2023.01	08/03/2022 03:11:48 PM US Eastern Daylight Time	08/04/2022 09:48:33 AM Eastern Daylight Time	07/31/2022 01:51:00 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Devoted Health	www.Devoted.com	Devoted GIVEBACK North Carolina (HMO)	01	01		1			H5299	002	0	2023	Greensboro and Winston-Salem		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			
H5299	003	0	1	01	01	H5299_003_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:12:13 PM US Eastern Daylight Time	08/04/2022 09:48:58 AM Eastern Daylight Time	07/31/2022 01:51:21 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Devoted Health	www.Devoted.com	Devoted PRIME North Carolina (HMO)	01	01		1			H5299	003	0	2023	Greensboro and Winston-Salem		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			
H5302	012	0	1	01	01	H5302_012_0	4	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:40:50 PM Eastern Daylight Time	08/03/2022 01:02:26 PM Eastern Daylight Time	07/31/2022 11:12:12 PM Eastern Daylight Time			08/04/2022 05:34:59 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	2023	Atlanta 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			
H5302	013	0	1	01	01	H5302_013_0	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:41:11 PM Eastern Daylight Time	08/03/2022 01:03:48 PM Eastern Daylight Time	07/31/2022 11:12:38 PM Eastern Daylight Time			08/04/2022 05:34:59 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	2023	Cobb County		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			
H5302	014	0	1	01	01	H5302_014_0	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 01:41:28 PM Eastern Daylight Time	08/03/2022 01:04:57 PM Eastern Daylight Time	07/31/2022 11:13:06 PM Eastern Daylight Time			08/04/2022 05:34:59 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	2023	Savannah		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			
H5302	018	0	1	01	01	H5302_018_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 06:17:03 PM Eastern Daylight Time	08/03/2022 01:06:00 PM Eastern Daylight Time	07/31/2022 11:13:30 PM Eastern Daylight Time			08/04/2022 05:34:59 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H5302	018	0	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 06:18:17 PM Eastern Daylight Time	08/03/2022 01:07:05 PM Eastern Daylight Time	07/31/2022 11:13:56 PM Eastern Daylight Time			08/04/2022 05:34:59 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H5302	019	0	2023	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	020	0	1	01	01	H5302_020_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 09:47:15 PM Eastern Daylight Time	08/03/2022 01:08:30 PM Eastern Daylight Time	07/31/2022 11:14:22 PM Eastern Daylight Time			08/04/2022 05:34:59 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Select Plan (HMO D-SNP)	01	01		1			H5302	020	0	2023	Select Counties in Georgia		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		(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	05/27/2022	2023.01	05/27/2022 03:59:52 PM Eastern Daylight Time					06/02/2022 03:28:05 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5302	809	0	2023	Georgia		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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;8b1;14d;14e2;18a;	1					1				
H5302	810	0	1	01	01	H5302_810_0	1	1						05/27/2022	2023.01	05/27/2022 04:14:12 PM Eastern Daylight Time					06/02/2022 03:28:05 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H5302	810	0	2023	Georgia		1	430	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H5322	001	0	1	02	01	H5322_001_0	3	1		1	2			08/15/2022	2023.01	08/15/2022 11:10:56 AM Central Daylight Time	08/03/2022 11:47:23 AM Central Daylight Time	07/31/2022 03:24:07 AM Central Daylight Time			08/15/2022 04:56:38 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	2023	Clermont and Trumbull 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			
H5322	003	0	1	02	01	H5322_003_0	4	1		1	2			08/15/2022	2023.01	08/15/2022 11:11:04 AM Central Daylight Time	08/03/2022 11:47:56 AM Central Daylight Time	07/31/2022 03:24:32 AM Central Daylight Time			08/15/2022 04:56:38 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	2023	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	4	1		1	2			08/15/2022	2023.01	08/15/2022 11:11:13 AM Central Daylight Time	08/03/2022 11:48:30 AM Central Daylight Time	07/31/2022 03:24:58 AM Central Daylight Time			08/15/2022 04:56:38 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	2023	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	02	01	H5322_025_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:45:51 PM Central Daylight Time	08/03/2022 11:49:04 AM Central Daylight Time	07/31/2022 03:25:23 AM Central Daylight Time			08/05/2022 10:51:58 AM 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	025	0	2023	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	02	01	H5322_026_0	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:45:59 PM Central Daylight Time	08/03/2022 11:49:39 AM Central Daylight Time	07/31/2022 03:25:49 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H5322	026	0	2023	Cameron, Hidalgo, and Willacy Counties		2		2			1	3		2					2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	028	0	1	02	01	H5322_028_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 11:52:04 AM Central Daylight Time	08/03/2022 11:50:13 AM Central Daylight Time	07/31/2022 03:26:14 AM Central Daylight Time			08/04/2022 02:59:25 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	2023	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	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:10:18 PM Central Daylight Time	08/03/2022 11:50:47 AM Central Daylight Time	07/31/2022 03:26:40 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:40:33 AM Central Daylight Time	08/03/2022 11:51:21 AM Central Daylight Time	07/31/2022 03:27:05 AM Central Daylight Time			08/04/2022 04:34:56 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	2023	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	02	01	H5322_031_0	4	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 01:05:10 PM Central Daylight Time	08/03/2022 11:51:55 AM Central Daylight Time	07/31/2022 03:27:31 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	031	0	2023	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			
H5322	033	0	1	02	01	H5322_033_0	4	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:18:43 PM Central Daylight Time	08/03/2022 11:52:29 AM Central Daylight Time	07/31/2022 03:27:56 AM Central Daylight Time			08/05/2022 11:15:56 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H5322	033	0	2023	State of Oklahoma		2		2			1	3		2					2	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			
H5322	034	0	1	02	01	H5322_034_0	3	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 10:39:52 AM Central Daylight Time	08/03/2022 11:53:03 AM Central Daylight Time	07/31/2022 03:28:22 AM Central Daylight Time			08/12/2022 01:40:29 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H5322	034	0	2023	Select counties in Ohio		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			
H5325	001	0	1	01	01	H5325_001_0	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 05:23:39 PM Central Daylight Time	08/02/2022 04:44:33 PM Central Daylight Time	07/31/2022 10:14:50 PM Central Daylight Time			08/05/2022 11:14:22 AM 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 05:24:09 PM Central Daylight Time	08/02/2022 04:45:35 PM Central Daylight Time	07/31/2022 10:15:16 PM Central Daylight Time			08/05/2022 11:14:22 AM 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 03:29:51 PM Central Daylight Time	08/02/2022 04:46:40 PM Central Daylight Time	07/31/2022 10:15:42 PM Central Daylight Time			08/05/2022 11:14:22 AM 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 03:30:47 PM Central Daylight Time	08/02/2022 04:47:47 PM Central Daylight Time	07/31/2022 10:16:08 PM Central Daylight Time			08/05/2022 11:14:22 AM 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 03:01:14 PM Central Daylight Time	08/02/2022 01:27:13 PM Central Daylight Time	07/31/2022 10:16:36 PM Central Daylight Time			08/05/2022 11:14:22 AM 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	2023	Metro St Louis-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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 03:02:02 PM Central Daylight Time	08/02/2022 01:28:19 PM Central Daylight Time	07/31/2022 10:17:02 PM Central Daylight Time			08/05/2022 11:14:22 AM 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	2023	Eastern/Central 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	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 03:31:53 PM Central Daylight Time	08/02/2022 04:48:56 PM Central Daylight Time	07/31/2022 10:17:28 PM Central Daylight Time			08/05/2022 11:14:22 AM 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	009	0	1	01	01	H5325_009_0	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 03:32:42 PM Central Daylight Time	08/02/2022 04:50:06 PM Central Daylight Time	07/31/2022 10:17:54 PM Central Daylight Time			08/05/2022 11:14:22 AM 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	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5372	001	0	1	02	01	H5372_001_0	6	1					1	08/02/2022	2023.01	08/02/2022 03:32:19 PM Central Daylight Time	08/05/2022 05:23:09 AM Central Daylight Time	08/05/2022 05:22:40 AM Central Daylight Time			08/05/2022 05:46:12 AM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO-POS)	01	02		1			H5372	001	0	2023	Northeast Georgia		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5372	801	0	1	02	01	H5372_801_0	2	1						05/10/2022	2023.01	05/10/2022 08:37:26 AM Central Daylight Time					06/03/2022 12:34:43 PM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage MAPD Calendar Year (HMO-POS)	01	02		1			H5372	801	0	2023	Northeast Georgia		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5372	802	0	1	02	01	H5372_802_0	2	1						05/10/2022	2023.01	05/10/2022 08:37:09 AM Central Daylight Time					06/03/2022 12:34:43 PM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage MAPD non-Calendar Year (HMO-POS)	01	02		1			H5372	802	0	2023	Northeast Georgia		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5372	803	0	1	02	01	H5372_803_0	2	1				0	0	05/10/2022	2023.01	05/10/2022 08:38:54 AM Central Daylight Time					06/03/2022 12:34:43 PM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only Calendar Year (HMO-POS)	01	02		1			H5372	803	0	2023	Northeast Georgia		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5372	804	0	1	02	01	H5372_804_0	2	1				0	0	05/10/2022	2023.01	05/10/2022 08:41:11 AM Central Daylight Time					06/03/2022 12:34:43 PM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only non-Calendar Year (HMO-POS)	01	02		1			H5372	804	0	2023	Northeast Georgia		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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				
H5373	001	0	1	01	01	H5373_001_0	7	1					1	08/03/2022	2023.01	08/03/2022 02:54:58 PM Eastern Daylight Time	08/05/2022 08:53:52 AM Eastern Daylight Time	08/05/2022 08:53:52 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE OF INDIANA, INC.	ProMedica Medicare Plan	promedicahealthplan.com/medicare	ProMedica Medicare Essential (HMO)	01	01		1			H5373	001	0	2023	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			
H5373	002	0	1	02	01	H5373_002_0	5	1					0	08/03/2022	2023.01	08/03/2022 02:56:29 PM Eastern Daylight Time	08/05/2022 08:53:53 AM Eastern Daylight Time	08/05/2022 08:53:53 AM Eastern Daylight Time			08/05/2022 08:59:48 AM Eastern Daylight Time	PARAMOUNT CARE OF INDIANA, INC.	ProMedica Medicare Plan	promedicahealthplan.com/map	MAP Medicare (HMO-POS)	01	02		1			H5373	002	0	2023	Dearborn County IN		2		2			2									promedicahealthplan.com/map	promedicahealthplan.com/map	promedicahealthplan.com/map	(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(833)585-3388		(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	10	1		1				08/03/2022	2023.01	08/03/2022 04:58:27 PM Central Daylight Time	08/04/2022 12:20:23 PM Central Daylight Time	08/02/2022 08:36:45 AM Central Daylight Time			08/04/2022 03:18:36 PM Central 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	2023	NC (Partial)		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	4	1			1		1	06/03/2022	2023.01	06/03/2022 10:37:22 AM Eastern Daylight Time	08/03/2022 04:30:15 PM Eastern Daylight Time	07/30/2022 08:23:40 AM Eastern Daylight Time			08/04/2022 04:33:47 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	2023	Danville, Lynchburg and Roanoke areas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5377	002	0	1	02	01	H5377_002_0	4	1			1		1	08/02/2022	2023.01	08/02/2022 02:09:24 PM Eastern Daylight Time	08/03/2022 04:31:12 PM Eastern Daylight Time	07/30/2022 08:24:04 AM Eastern Daylight Time			08/04/2022 04:33:47 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5377-002 (HMO-POS)	01	02		1			H5377	002	0	2023	Roanoke		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5386	003	0	1	01	01	H5386_003_0	3	1					1	08/05/2022	2023.01	08/05/2022 05:24:48 PM Pacific Daylight Time	08/04/2022 10:33:04 AM Pacific Daylight Time	07/29/2022 02:05:06 PM Pacific Daylight Time			08/05/2022 05:34:37 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Gold Card (HMO)	01	01		1			H5386	003	0	2023	Sharp Direct Advantage Gold San Diego County		2		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	3	1					1	08/05/2022	2023.01	08/05/2022 05:27:31 PM Pacific Daylight Time	08/04/2022 10:34:33 AM Pacific Daylight Time	07/29/2022 02:05:54 PM Pacific Daylight Time			08/05/2022 05:34:37 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Platinum Card (HMO)	01	01		1			H5386	004	0	2023	Sharp Direct Advantage Platinum San Diego County		2		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	3	1					1	08/05/2022	2023.01	08/05/2022 05:30:46 PM Pacific Daylight Time	08/04/2022 10:36:02 AM Pacific Daylight Time	07/29/2022 02:06:27 PM Pacific Daylight Time			08/05/2022 05:34:37 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage VIP Plan (HMO)	01	01		1			H5386	005	0	2023	Sharp Direct Advantage VIP San Diego County		2		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	1	1						06/03/2022	2023.01	06/03/2022 02:19:36 PM Pacific Daylight Time					06/03/2022 02:26:09 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Calendar Year (HMO)	01	01		1			H5386	801	0	2023	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	1	1						06/03/2022	2023.01	06/03/2022 02:20:00 PM Pacific Daylight Time					06/03/2022 02:26:09 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	2023	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	1	1				0	0	06/03/2022	2023.01	06/03/2022 02:20:16 PM Pacific Daylight Time					06/03/2022 02:26:09 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage MA Only (HMO)	01	01		1			H5386	803	0	2023	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	002	0	1	01	01	H5398_002_0	5	1						08/01/2022	2023.01	08/01/2022 12:45:16 PM Central Daylight Time	08/03/2022 09:28:44 PM Eastern Daylight Time	07/30/2022 09:38:15 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Via Christi Secure (HMO)	01	01		1			H5398	002	0	2023	Select counties in Kansas		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)816-6623		(833)816-6623		(844)917-0175		(844)917-0175		(833)816-6623		(833)816-6623		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5398	004	0	1	01	01	H5398_004_0	5	1						08/01/2022	2023.01	08/01/2022 12:46:13 PM Central Daylight Time	08/03/2022 09:29:51 PM Eastern Daylight Time	07/30/2022 09:38:46 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Via Christi Reward II (HMO)	01	01		1			H5398	004	0	2023	Select Counties in Kansas		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)816-6623		(833)816-6623		(866)281-2878		(866)281-2878		(833)816-6623		(833)816-6623		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5403	001	0	1	20	08	H5403_001_0	1	1						06/03/2022	2023.01	06/03/2022 09:50:56 PM Pacific Daylight Time		06/03/2022 09:19:17 PM Pacific Daylight Time			06/03/2022 09:55:03 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	2023	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						06/03/2022	2023.01	06/03/2022 09:52:15 PM Pacific Daylight Time		06/03/2022 09:19:17 PM Pacific Daylight Time			06/03/2022 09:55:03 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	2023	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						06/01/2022	2023.01	06/01/2022 10:08:03 AM Pacific Daylight Time		05/31/2022 05:14:56 PM Pacific Daylight Time			06/01/2022 10:11:15 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	2023	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						06/01/2022	2023.01	06/01/2022 10:09:19 AM Pacific Daylight Time		05/31/2022 05:14:55 PM Pacific Daylight Time			06/01/2022 10:11:15 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	2023	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						05/26/2022	2023.01	05/26/2022 10:21:13 AM Pacific Daylight Time		05/26/2022 10:16:46 AM Pacific Daylight Time			05/26/2022 10:24:02 AM Pacific Daylight Time	SUTTER VALLEY HOSPITALS	Sutter SeniorCare PACE	www.sutterhealth.org/pace	Sutter SeniorCare (PACE)	08	20		1			H5406	001	0	2023	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						05/26/2022	2023.01	05/26/2022 10:21:31 AM Pacific Daylight Time		05/26/2022 10:16:46 AM Pacific Daylight Time			05/26/2022 10:24:02 AM Pacific Daylight Time	SUTTER VALLEY HOSPITALS	Sutter SeniorCare PACE	www.sutterhealth.org/pace	Sutter SeniorCare (PACE)	08	20		1			H5406	002	0	2023	Sacramento County		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	004	0	1	01	01	H5410_004_0	2	1				0	0	06/01/2022	2023.01	06/01/2022 09:33:28 PM Central Daylight Time	05/31/2022 01:46:53 PM Central Daylight Time				06/02/2022 10:47:50 AM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H5410	004	0	2023	North Florida		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5410	013	0	1	01	01	H5410_013_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 07:07:33 PM Central Daylight Time	08/02/2022 07:47:21 PM Central Daylight Time	08/01/2022 11:08:09 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H5410	013	0	2023	North Florida		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	018	0	1	01	01	H5410_018_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:27:28 PM Central Daylight Time	08/02/2022 04:17:42 PM Central Daylight Time	08/01/2022 11:08:41 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	018	0	2023	North Florida		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	024	0	1	01	01	H5410_024_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:52:34 PM Central Daylight Time	08/02/2022 01:56:13 PM Central Daylight Time	08/01/2022 11:09:13 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	024	0	2023	Orlando		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	025	0	1	01	01	H5410_025_0	4	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:49:48 PM Central Daylight Time	08/02/2022 03:49:09 PM Central Daylight Time	08/01/2022 11:09:46 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H5410	025	0	2023	Orlando		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	026	0	1	01	01	H5410_026_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:53:27 PM Central Daylight Time	08/02/2022 02:12:15 PM Central Daylight Time	08/01/2022 11:10:18 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	026	0	2023	Orlando		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	027	0	1	01	01	H5410_027_0	5	1			2		1	08/02/2022	2023.01	08/02/2022 04:57:39 PM Central Daylight Time	08/02/2022 02:16:06 PM Central Daylight Time	08/01/2022 11:10:49 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	027	0	2023	Daytona		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	028	0	1	01	01	H5410_028_0	5	1			2		1	08/02/2022	2023.01	08/02/2022 04:59:30 PM Central Daylight Time	08/02/2022 02:23:35 PM Central Daylight Time	08/01/2022 11:11:21 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	028	0	2023	Daytona		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	029	0	1	01	01	H5410_029_0	5	1			2		1	08/02/2022	2023.01	08/02/2022 05:00:21 PM Central Daylight Time	08/02/2022 02:25:10 PM Central Daylight Time	08/01/2022 11:11:53 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	029	0	2023	Tampa		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	030	0	1	01	01	H5410_030_0	5	1			2		1	08/02/2022	2023.01	08/02/2022 05:00:54 PM Central Daylight Time	08/02/2022 02:29:09 PM Central Daylight Time	08/01/2022 11:12:25 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	030	0	2023	Tampa		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	031	0	1	01	01	H5410_031_0	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:50:00 PM Central Daylight Time	08/03/2022 02:26:33 PM Central Daylight Time	08/01/2022 11:12:58 AM Central Daylight Time			08/05/2022 08:36:58 AM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H5410	031	0	2023	Daytona/Jacksonville		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	032	0	1	01	01	H5410_032_0	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:50:10 PM Central Daylight Time	08/03/2022 03:05:15 PM Central Daylight Time	08/01/2022 11:13:30 AM Central Daylight Time			08/05/2022 08:36:58 AM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H5410	032	0	2023	Tampa		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	033	0	1	01	01	H5410_033_0	4	1						05/31/2022	2023.01	05/31/2022 08:17:11 PM Central Daylight Time	08/02/2022 02:42:33 PM Central Daylight Time	08/01/2022 11:14:02 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H5410	033	0	2023	Orlando		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	034	0	1	01	01	H5410_034_0	4	1						05/28/2022	2023.01	05/28/2022 05:07:08 PM Central Daylight Time	08/02/2022 02:43:30 PM Central Daylight Time	08/01/2022 11:14:34 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H5410	034	0	2023	Daytona		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	035	0	1	01	01	H5410_035_0	5	1						05/28/2022	2023.01	05/28/2022 05:07:34 PM Central Daylight Time	08/03/2022 01:43:10 PM Central Daylight Time	08/01/2022 11:15:06 AM Central Daylight Time			08/04/2022 04:14:31 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H5410	035	0	2023	Tampa		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	037	0	1	01	01	H5410_037_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:58:24 PM Central Daylight Time	08/03/2022 08:38:18 AM Central Daylight Time	08/01/2022 11:15:38 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	037	0	2023	Treasure Coast		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	039	0	1	01	01	H5410_039_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:58:55 PM Central Daylight Time	08/03/2022 08:56:05 AM Central Daylight Time	08/01/2022 11:16:10 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	039	0	2023	Southwest Florida		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	040	0	1	01	01	H5410_040_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 07:59:43 PM Central Daylight Time	08/03/2022 09:08:18 AM Central Daylight Time	08/01/2022 11:16:41 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	040	0	2023	Treasure Coast		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	041	0	1	01	01	H5410_041_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:00:34 PM Central Daylight Time	08/03/2022 09:09:50 AM Central Daylight Time	08/01/2022 11:17:13 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	041	0	2023	Southwest Florida		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	042	0	1	01	01	H5410_042_0	4	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 02:50:26 PM Central Daylight Time	08/02/2022 07:55:38 PM Central Daylight Time	08/01/2022 11:17:45 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H5410	042	0	2023	North Florida		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	043	0	1	01	01	H5410_043_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 05:02:06 PM Central Daylight Time	08/02/2022 02:45:39 PM Central Daylight Time	08/01/2022 11:18:16 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	043	0	2023	Jacksonville		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	044	0	1	01	01	H5410_044_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 05:08:40 PM Central Daylight Time	08/02/2022 02:48:04 PM Central Daylight Time	08/01/2022 11:18:47 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	044	0	2023	Jacksonville		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	045	0	1	01	01	H5410_045_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 09:53:53 PM Central Daylight Time	08/02/2022 03:53:33 PM Central Daylight Time	08/01/2022 11:19:19 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H5410	045	0	2023	Daytona/Jacksonville		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	046	0	1	01	01	H5410_046_0	4	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 08:18:04 AM Central Daylight Time	08/02/2022 04:03:54 PM Central Daylight Time	08/01/2022 11:19:51 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H5410	046	0	2023	Orlando/Tampa		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	047	0	1	01	01	H5410_047_0	4	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 09:56:20 PM Central Daylight Time	08/03/2022 09:10:47 AM Central Daylight Time	08/01/2022 11:20:23 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H5410	047	0	2023	South Florida		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	048	0	1	01	01	H5410_048_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:01:07 PM Central Daylight Time	08/03/2022 09:16:08 AM Central Daylight Time	08/01/2022 11:20:55 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	048	0	2023	Broward		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	049	0	1	01	01	H5410_049_0	5	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 09:56:32 PM Central Daylight Time	08/03/2022 09:22:11 AM Central Daylight Time	08/01/2022 11:21:28 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H5410	049	0	2023	Southeast Florida		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	050	0	1	01	01	H5410_050_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:02:38 PM Central Daylight Time	08/03/2022 09:24:30 AM Central Daylight Time	08/01/2022 11:22:00 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	050	0	2023	Broward		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	051	0	1	01	01	H5410_051_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:03:11 PM Central Daylight Time	08/03/2022 09:26:44 AM Central Daylight Time	08/01/2022 11:22:32 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	051	0	2023	Miami-Dade		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	052	0	1	01	01	H5410_052_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:04:11 PM Central Daylight Time	08/03/2022 09:28:22 AM Central Daylight Time	08/01/2022 11:23:03 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	052	0	2023	Miami-Dade		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	053	0	1	01	01	H5410_053_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:04:57 PM Central Daylight Time	08/03/2022 09:29:14 AM Central Daylight Time	08/01/2022 11:23:34 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	053	0	2023	Palm Beach		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	054	0	1	01	01	H5410_054_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:05:38 PM Central Daylight Time	08/03/2022 09:30:34 AM Central Daylight Time	08/01/2022 11:24:05 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	054	0	2023	Palm Beach		2		2			2									www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	055	0	1	01	01	H5410_055_0	5	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 09:58:54 PM Central Daylight Time	08/03/2022 09:33:29 AM Central Daylight Time	08/01/2022 11:24:37 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H5410	055	0	2023	South Florida		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	056	0	1	01	01	H5410_056_0	5	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 09:56:48 PM Central Daylight Time	08/03/2022 09:36:38 AM Central Daylight Time	08/01/2022 11:25:10 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H5410	056	0	2023	Southeast Florida		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	808	0	1	01	01	H5410_808_0	3	1						06/15/2022	2023.01	06/15/2022 04:08:59 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignahealthspring.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	808	0	2023	Statewide FL		1	7464	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:21:24 AM Central Daylight Time	08/03/2022 10:20:04 AM Central Daylight Time	07/31/2022 03:28:47 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	Preferred Care Network, Inc.	UnitedHealthcare	www.PCNhealth.com	MedicareMax (HMO)	01	01		1			H5420	001	0	2023	Miami-Dade County		2		2			2									www.PCNhealth.com	www.PCNhealth.com	www.PCNhealth.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5420	003	0	1	01	01	H5420_003_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 09:21:38 AM Central Daylight Time	08/03/2022 10:20:34 AM Central Daylight Time	07/31/2022 03:29:11 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	Preferred Care Network, Inc.	UnitedHealthcare	www.PCNhealth.com	MedicareMax (HMO)	01	01		1			H5420	003	0	2023	Broward County		2		2			2									www.PCNhealth.com	www.PCNhealth.com	www.PCNhealth.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5420	006	0	1	01	01	H5420_006_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:22:23 AM Central Daylight Time	08/03/2022 10:21:05 AM Central Daylight Time	07/31/2022 03:29:37 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	Preferred Care Network, Inc.	UnitedHealthcare	www.PCNhealth.com	MedicareMax Plus (HMO D-SNP)	01	01		1			H5420	006	0	2023	Miami-Dade and Broward Counties		2		2			1	3		2					2	www.PCNhealth.com	www.PCNhealth.com	www.PCNhealth.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	014	0	1	01	01	H5420_014_0	2	1		1	2		1	08/03/2022	2023.01	08/03/2022 09:22:39 AM Central Daylight Time	08/03/2022 10:21:35 AM Central Daylight Time	07/31/2022 03:30:02 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	Preferred Care Network, Inc.	UnitedHealthcare	www.PCNhealth.com	MedicareMax Chronic (HMO C-SNP)	01	01		1			H5420	014	0	2023	Miami-Dade and Broward Counties		2		2			1	4			00000000000000000010000					www.PCNhealth.com	www.PCNhealth.com	www.PCNhealth.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	06/08/2022	2023.01	06/08/2022 02:33:51 PM Eastern Daylight Time	08/04/2022 06:21:10 PM Eastern Daylight Time	08/04/2022 06:38:25 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	7	1			2		1	06/08/2022	2023.01	06/08/2022 02:34:04 PM Eastern Daylight Time	08/04/2022 06:21:11 PM Eastern Daylight Time	08/04/2022 06:38:28 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 02:32:28 PM Eastern Daylight Time	08/04/2022 06:21:12 PM Eastern Daylight Time	08/04/2022 06:38:31 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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			1		0	08/01/2022	2023.01	08/01/2022 02:34:30 PM Eastern Daylight Time	08/04/2022 06:21:14 PM Eastern Daylight Time	08/04/2022 06:38:34 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	7	1			2	0	0	08/01/2022	2023.01	08/01/2022 02:35:44 PM Eastern Daylight Time	08/04/2022 06:21:15 PM Eastern Daylight Time				08/05/2022 08:46:26 AM 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	2023	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	6	1		1	2		0	08/02/2022	2023.01	08/02/2022 12:52:04 AM Pacific Daylight Time		08/04/2022 03:36:33 PM Pacific Daylight Time		08/04/2022 03:20:11 PM Pacific Daylight Time	08/19/2022 08:29:30 AM 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	2023	Select Counties in GA		2		2			1	4			00000000100000000000000					https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(833)681-2641		(833)681-2641		(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	6	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 12:09:02 PM Eastern Daylight Time	08/04/2022 06:21:17 PM Eastern Daylight Time	08/04/2022 06:38:36 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 02:36:54 PM Eastern Daylight Time	08/04/2022 06:21:18 PM Eastern Daylight Time	08/04/2022 06:38:39 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	018	0	1	01	01	H5422_018_0	7	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 05:30:05 PM Eastern Daylight Time	08/04/2022 06:21:20 PM Eastern Daylight Time	08/04/2022 06:38:41 PM Eastern Daylight Time			08/04/2022 07:09:53 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 Enhanced Care (HMO D-SNP)	01	01		1			H5422	018	0	2023	Select counties in GA		2		2			1	3		2					2	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	803	0	1	01	01	H5422_803_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:08:47 AM Pacific Daylight Time					06/03/2022 10:41:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5422	804	0	1	01	01	H5422_804_0	2	1						05/20/2022	2023.01	05/20/2022 11:27:47 AM Pacific Daylight Time					06/03/2022 10:41:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5422	806	0	2	01	01	H5422_806_0	2	1						05/20/2022	2023.01	05/20/2022 11:29:04 AM Pacific Daylight Time					06/03/2022 10:41:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5422	807	0	2	01	01	H5422_807_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:30:15 AM Pacific Daylight Time					06/03/2022 10:41:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5422	809	0	1	01	01	H5422_809_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:34:15 AM Pacific Daylight Time					06/03/2022 10:41:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5422	811	0	2	01	01	H5422_811_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:46:18 AM Pacific Daylight Time					06/03/2022 10:41:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5425	001	0	1	01	01	H5425_001_0	8	1			2		1	08/03/2022	2023.01	08/03/2022 05:55:42 PM Pacific Daylight Time	08/03/2022 07:47:13 PM Pacific Daylight Time	08/02/2022 09:59:24 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	001	0	2023	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	8	1			2		1	08/03/2022	2023.01	08/03/2022 05:56:15 PM Pacific Daylight Time	08/03/2022 07:47:46 PM Pacific Daylight Time	08/02/2022 09:59:38 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	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	8	1			2		1	08/03/2022	2023.01	08/03/2022 02:50:50 PM Pacific Daylight Time	08/04/2022 11:43:24 AM Pacific Daylight Time	08/02/2022 09:59:51 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	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	8	1			2		1	08/03/2022	2023.01	08/03/2022 02:51:46 PM Pacific Daylight Time	08/04/2022 11:44:01 AM Pacific Daylight Time	08/02/2022 10:00:05 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	006	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 02:53:25 PM Pacific Daylight Time	08/04/2022 11:44:34 AM Pacific Daylight Time	08/02/2022 10:00:19 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	007	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 02:54:34 PM Pacific Daylight Time	08/04/2022 11:45:07 AM Pacific Daylight Time	08/02/2022 10:00:33 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	008	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 02:55:34 PM Pacific Daylight Time	08/04/2022 11:45:38 AM Pacific Daylight Time	08/02/2022 10:00:47 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	009	0	2023	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	10	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 02:56:19 PM Pacific Daylight Time	08/04/2022 11:46:10 AM Pacific Daylight Time	08/03/2022 11:30:10 AM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections (HMO D-SNP)	01	01		1			H5425	010	0	2023	Los Angeles, Inland Empire, and San Diego 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	8	1			2		1	05/25/2022	2023.01	05/25/2022 09:27:01 AM Pacific Daylight Time	08/04/2022 08:53:19 AM Pacific Daylight Time	08/02/2022 10:01:01 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	019	0	2023	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	9	1			2		1	07/11/2022	2023.01	07/11/2022 08:43:01 AM Pacific Daylight Time	08/04/2022 08:53:51 AM Pacific Daylight Time	08/02/2022 10:01:15 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	020	0	2023	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	1	01	7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;17a;	
H5425	028	0	1	01	01	H5425_028_0	7	1		1	2		1	08/03/2022	2023.01	08/03/2022 02:57:24 PM Pacific Daylight Time	08/03/2022 07:52:30 PM Pacific Daylight Time	08/02/2022 10:01:30 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	Orange County		2		2			1	4			00000000000000010000000					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	9	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 03:00:05 PM Pacific Daylight Time	08/04/2022 11:46:44 AM Pacific Daylight Time	08/03/2022 11:30:13 AM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	Los Angeles, Inland Empire, and San Diego 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	7	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:02:26 PM Pacific Daylight Time	08/04/2022 11:47:18 AM Pacific Daylight Time	08/02/2022 10:01:44 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	Riverside and San Bernardino Counties		2		2			1	4			00000000000000010000000					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	7	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:03:11 PM Pacific Daylight Time	08/03/2022 07:54:01 PM Pacific Daylight Time	08/02/2022 10:01:58 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	034	0	2023	Los Angeles and Orange Counties		2		2			1	4			00000010000000000000000					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	8	1			2		1	05/24/2022	2023.01	05/24/2022 02:00:09 PM Pacific Daylight Time	08/04/2022 08:54:24 AM Pacific Daylight Time	08/02/2022 10:02:12 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	052	0	2023	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	7	1		1	2		1	05/24/2022	2023.01	05/24/2022 02:16:34 PM Pacific Daylight Time	08/04/2022 08:54:56 AM Pacific Daylight Time	08/02/2022 10:02:26 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	Napa and Sonoma Counties		2		2			1	4			00000000000000010000000					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	8	1		1	2		1	05/24/2022	2023.01	05/24/2022 02:18:55 PM Pacific Daylight Time	08/04/2022 08:55:29 AM Pacific Daylight Time	08/02/2022 10:02:40 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	054	0	2023	Napa and Sonoma Counties		2		2			1	4			00000010000000000000000					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	8	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:05:05 PM Pacific Daylight Time	08/04/2022 11:47:50 AM Pacific Daylight Time	08/02/2022 10:02:55 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	San Diego County		2		2			1	4			00000000000000010000000					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	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:05:40 PM Pacific Daylight Time	08/03/2022 07:57:20 PM Pacific Daylight Time	08/02/2022 10:03:10 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	065	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:06:14 PM Pacific Daylight Time	08/03/2022 07:57:52 PM Pacific Daylight Time	08/02/2022 10:03:24 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	066	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:06:30 PM Pacific Daylight Time	08/03/2022 07:58:24 PM Pacific Daylight Time	08/02/2022 10:03:38 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	067	0	2023	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	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:07:51 PM Pacific Daylight Time	08/03/2022 07:58:55 PM Pacific Daylight Time	08/02/2022 10:03:52 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	068	0	2023	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	9	1			2		1	08/03/2022	2023.01	08/03/2022 05:53:20 PM Pacific Daylight Time	08/03/2022 07:59:25 PM Pacific Daylight Time	08/02/2022 10:04:06 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	069	0	2023	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	1	01	7c;7d;7e1;7e2;7g;7h1;7h2;7i;	
H5425	070	0	1	01	01	H5425_070_0	9	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:08:48 PM Pacific Daylight Time	08/03/2022 07:59:55 PM Pacific Daylight Time	08/02/2022 10:04:20 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	070	0	2023	Stanislaus County		2		2			1	4			00000010000000000000000					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	1	01	7c;7d;7e1;7e2;7g;7h1;7h2;7i;	
H5425	073	0	1	01	01	H5425_073_0	9	1			2		1	08/03/2022	2023.01	08/03/2022 03:09:14 PM Pacific Daylight Time	08/03/2022 08:01:08 PM Pacific Daylight Time	08/02/2022 10:04:34 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Options (HMO)	01	01		1			H5425	073	0	2023	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	1	01	7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;17a;	
H5425	074	0	1	01	01	H5425_074_0	8	1			2		1	05/24/2022	2023.01	05/24/2022 02:02:26 PM Pacific Daylight Time	08/04/2022 08:56:00 AM Pacific Daylight Time	08/02/2022 10:04:48 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Compass (HMO)	01	01		1			H5425	074	0	2023	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	8	1			2		1	08/03/2022	2023.01	08/03/2022 03:10:13 PM Pacific Daylight Time	08/03/2022 08:02:13 PM Pacific Daylight Time	08/02/2022 10:05:02 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	075	0	2023	Alameda 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	076	0	1	01	01	H5425_076_0	8	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:10:39 PM Pacific Daylight Time	08/03/2022 08:02:46 PM Pacific Daylight Time	08/02/2022 10:05:16 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	076	0	2023	Alameda County		2		2			1	4			00000010000000000000000					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	077	0	1	01	01	H5425_077_0	8	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:11:02 PM Pacific Daylight Time	08/03/2022 08:03:23 PM Pacific Daylight Time	08/02/2022 10:05:30 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	Alameda County		2		2			1	4			00000000000000010000000					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	078	0	1	01	01	H5425_078_0	8	1			2		1	08/03/2022	2023.01	08/03/2022 03:11:28 PM Pacific Daylight Time	08/03/2022 08:03:54 PM Pacific Daylight Time	08/02/2022 10:05:44 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	078	0	2023	San Mateo 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	079	0	1	01	01	H5425_079_0	8	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:11:56 PM Pacific Daylight Time	08/03/2022 08:04:26 PM Pacific Daylight Time	08/02/2022 10:05:57 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	079	0	2023	San Mateo County		2		2			1	4			00000010000000000000000					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	080	0	1	01	01	H5425_080_0	8	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:12:26 PM Pacific Daylight Time	08/03/2022 08:04:57 PM Pacific Daylight Time	08/02/2022 10:06:11 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	San Mateo County		2		2			1	4			00000000000000010000000					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	082	0	1	01	01	H5425_082_0	8	1			2		1	08/03/2022	2023.01	08/03/2022 03:18:05 PM Pacific Daylight Time	08/03/2022 08:05:28 PM Pacific Daylight Time	08/02/2022 10:06:25 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Alta (HMO)	01	01		1			H5425	082	0	2023	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	083	0	1	01	01	H5425_083_0	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:19:24 PM Pacific Daylight Time	08/03/2022 08:05:58 PM Pacific Daylight Time	08/02/2022 10:06:39 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Options (HMO)	01	01		1			H5425	083	0	2023	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	084	0	1	01	01	H5425_084_0	8	1			2		1	08/03/2022	2023.01	08/03/2022 03:27:08 PM Pacific Daylight Time	08/03/2022 08:06:29 PM Pacific Daylight Time	08/02/2022 10:06:53 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H5425	084	0	2023	Los Angeles and Orange 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	085	0	1	01	01	H5425_085_0	8	1			2		1	08/03/2022	2023.01	08/03/2022 03:27:42 PM Pacific Daylight Time	08/03/2022 08:07:00 PM Pacific Daylight Time	08/02/2022 10:07:07 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H5425	085	0	2023	Riverside and San Bernardino 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	086	0	1	01	01	H5425_086_0	8	1		1	1		1	08/03/2022	2023.01	08/03/2022 03:28:45 PM Pacific Daylight Time	08/03/2022 08:07:31 PM Pacific Daylight Time	08/02/2022 10:07:21 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Embrace (HMO I-SNP)	01	01		1			H5425	086	0	2023	Los Angeles County		2		2			1	1	3							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	087	0	1	01	01	H5425_087_0	8	1		1	1		1	08/03/2022	2023.01	08/03/2022 03:35:07 PM Pacific Daylight Time	08/03/2022 08:08:02 PM Pacific Daylight Time	08/02/2022 10:07:35 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Embrace (HMO I-SNP)	01	01		1			H5425	087	0	2023	Orange County		2		2			1	1	3							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	091	0	1	01	01	H5425_091_0	8	1		1	1		1	08/03/2022	2023.01	08/03/2022 03:35:28 PM Pacific Daylight Time	08/03/2022 08:08:34 PM Pacific Daylight Time	08/02/2022 10:07:49 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Embrace (HMO I-SNP)	01	01		1			H5425	091	0	2023	San Bernardino County		2		2			1	1	3							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	092	0	1	01	01	H5425_092_0	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:36:34 PM Pacific Daylight Time	08/04/2022 11:48:20 AM Pacific Daylight Time	08/02/2022 10:08:03 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Affirm partnered with Included LGBTQ+ Health (HMO)	01	01		1			H5425	092	0	2023	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	093	0	1	01	01	H5425_093_0	7	1			2		1	08/03/2022	2023.01	08/03/2022 03:37:25 PM Pacific Daylight Time	08/04/2022 11:48:51 AM Pacific Daylight Time	08/02/2022 10:08:17 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Affirm partnered with Included LGBTQ+ Health (HMO)	01	01		1			H5425	093	0	2023	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	803	0	1	01	01	H5425_803_0	6	1						06/03/2022	2023.01	06/03/2022 09:22:16 AM Pacific Daylight Time					06/05/2022 04:42:03 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H5425	803	0	2023	Southern and Northern California Counties		1	28549	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	804	0	1	01	01	H5425_804_0	6	1						06/03/2022	2023.01	06/03/2022 09:22:32 AM Pacific Daylight Time					06/05/2022 04:42:03 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H5425	804	0	2023	Southern and Northern California Counties		1	11314	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	806	0	1	01	01	H5425_806_0	6	1				0	0	06/03/2022	2023.01	06/03/2022 09:22:55 AM Pacific Daylight Time					06/05/2022 04:42:03 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H5425	806	0	2023	Select CA Counties		1	0	2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5425	807	0	1	01	01	H5425_807_0	6	1				0	0	06/03/2022	2023.01	06/03/2022 09:23:17 AM Pacific Daylight Time					06/05/2022 04:42:03 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H5425	807	0	2023	Select CA Counties		1	0	2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5427	052	0	1	01	01	H5427_052_0	4	1			2	0	0	05/14/2022	2023.01	05/14/2022 09:19:44 AM Eastern Daylight Time	07/19/2022 10:00:00 PM Eastern Daylight Time				07/19/2022 06:27:36 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Savings Plan (HMO)	01	01		1			H5427	052	0	2023	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5427	059	0	1	01	01	H5427_059_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:20:35 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	059	0	2023	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	060	0	1	01	01	H5427_060_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:21:18 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	060	0	2023	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	070	0	1	01	01	H5427_070_0	6	1		1	2		1	05/14/2022	2023.01	05/14/2022 09:22:22 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		2			1	4			00000000000000000010000					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	6	1		1	2		1	05/14/2022	2023.01	05/14/2022 09:23:12 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		2			1	4			00000000000000000010000					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	5	1		1	2		0	05/14/2022	2023.01	05/14/2022 09:24:03 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		2			1	4			00000000000100000000000					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	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 09:57:21 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		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	6	1		1	2		0	05/14/2022	2023.01	05/14/2022 09:25:20 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		2			1	4			00000000000000000010000					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	6	1		1	2		0	05/14/2022	2023.01	05/14/2022 09:25:44 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		2			1	4			00000000000100000000000					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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 09:59:41 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:26:41 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	089	0	1	01	01	H5427_089_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:27:28 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	091	0	1	01	01	H5427_091_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:28:10 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	092	0	1	01	01	H5427_092_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:28:53 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	093	0	1	01	01	H5427_093_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:29:26 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	094	0	1	01	01	H5427_094_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:30:05 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	096	0	1	01	01	H5427_096_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:30:48 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:31:11 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	098	0	2023	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	099	0	1	01	01	H5427_099_0	6	1		1	2		1	05/14/2022	2023.01	05/14/2022 09:31:51 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	select counties in FL		2		2			1	4			00000000000000000010000					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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:32:41 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:33:46 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:34:27 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	105	0	1	01	01	H5427_105_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:34:55 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:35:18 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:35:54 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	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	6	1		1	2		0	05/14/2022	2023.01	05/14/2022 09:36:16 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	select counties in FL		2		2			1	4			00000000000000000010000					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	109	0	1	01	01	H5427_109_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:36:41 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Platinum Plus Plan Rx (HMO)	01	01		1			H5427	109	0	2023	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	110	0	1	01	01	H5427_110_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:37:15 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Platinum Plus Plan Rx (HMO)	01	01		1			H5427	110	0	2023	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	111	0	1	01	01	H5427_111_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:37:41 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Platinum Plus Plan Rx (HMO)	01	01		1			H5427	111	0	2023	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			
H5430	805	0	1	01	01	H5430_805_0	1	1						05/10/2022	2023.01	05/10/2022 11:17:17 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Group Medicare Advantage (HMO)	01	01		1			H5430	805	0	2023	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)917-0175		(844)917-0175		(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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:17:22 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Group Medicare Advantage (HMO)	01	01		1			H5430	806	0	2023	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)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:17:26 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Group Medicare Advantage (HMO)	01	01		1			H5430	807	0	2023	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)917-0175		(844)917-0175		(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	6	1			2			08/01/2022	2023.01	08/01/2022 01:51:14 PM Eastern Daylight Time	08/04/2022 06:21:37 PM Eastern Daylight Time	08/04/2022 06:39:16 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	6	1			1			08/01/2022	2023.01	08/01/2022 01:54:37 PM Eastern Daylight Time	08/04/2022 06:21:39 PM Eastern Daylight Time	08/04/2022 06:39:19 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun MediMax (HMO)	01	01		1			H5431	006	0	2023	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	6	1			2			08/01/2022	2023.01	08/01/2022 01:54:21 PM Eastern Daylight Time	08/04/2022 06:21:40 PM Eastern Daylight Time	08/04/2022 06:39:22 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	6	1			2			08/01/2022	2023.01	08/01/2022 01:56:48 PM Eastern Daylight Time	08/04/2022 06:21:42 PM Eastern Daylight Time	08/04/2022 06:39:24 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	016	0	1	01	01	H5431_016_0	6	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 02:00:42 PM Eastern Daylight Time	08/04/2022 06:21:43 PM Eastern Daylight Time	08/04/2022 06:39:27 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	6	1			2			08/01/2022	2023.01	08/01/2022 02:02:36 PM Eastern Daylight Time	08/04/2022 06:21:44 PM Eastern Daylight Time	08/04/2022 06:39:30 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	6	1			2			08/01/2022	2023.01	08/01/2022 02:03:39 PM Eastern Daylight Time	08/04/2022 06:21:46 PM Eastern Daylight Time	08/04/2022 06:39:32 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	8	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 02:05:05 PM Eastern Daylight Time	08/04/2022 06:21:47 PM Eastern Daylight Time	08/04/2022 06:39:35 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	020	0	1	01	01	H5431_020_0	6	1			2			08/01/2022	2023.01	08/01/2022 02:05:55 PM Eastern Daylight Time	08/04/2022 06:21:48 PM Eastern Daylight Time	08/04/2022 06:39:38 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun HealthAdvantage Plus (HMO)	01	01		1			H5431	020	0	2023	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			
H5433	001	0	1	01	01	H5433_001_0	5	1	2	1			0	08/03/2022	2023.01	08/03/2022 05:39:21 PM Pacific Daylight Time	08/04/2022 01:07:47 PM Pacific Daylight Time	08/04/2022 01:07:52 PM Pacific Daylight Time			08/04/2022 04:11:34 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	2023	Orange County, California		2		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	06/05/2022	2023.01	06/05/2022 01:30:00 PM Eastern Daylight Time	08/04/2022 12:29:03 PM Eastern Daylight Time	08/03/2022 09:55:09 PM Eastern Daylight Time			08/05/2022 06:12:42 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	2023	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	6	1					1	08/03/2022	2023.01	08/03/2022 04:07:57 PM Eastern Daylight Time	08/04/2022 05:43:48 PM Eastern Daylight Time	08/03/2022 09:55:42 PM Eastern Daylight Time			08/05/2022 06:12:42 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	2023	Pinellas 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	7d;16b;17a;18a;	
H5434	024	0	1	04	01	H5434_024_0	6	1					1	08/03/2022	2023.01	08/03/2022 04:11:17 PM Eastern Daylight Time	08/04/2022 05:44:22 PM Eastern Daylight Time	08/03/2022 04:50:12 PM Eastern Daylight Time			08/05/2022 06:12:42 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	2023	West Coast 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	7d;16b;17a;18a;	
H5434	025	0	1	04	01	H5434_025_0	6	1					1	08/03/2022	2023.01	08/03/2022 04:14:49 PM Eastern Daylight Time	08/04/2022 05:44:54 PM Eastern Daylight Time	08/03/2022 04:54:42 PM Eastern Daylight Time			08/05/2022 06:12:42 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	2023	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	08/03/2022	2023.01	08/03/2022 04:17:24 PM Eastern Daylight Time	08/04/2022 05:45:25 PM Eastern Daylight Time	08/03/2022 04:59:30 PM Eastern Daylight Time			08/05/2022 06:42:07 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	2023	South 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	7d;16b;17a;18a;	
H5434	030	0	1	04	01	H5434_030_0	6	1					1	08/03/2022	2023.01	08/03/2022 04:19:59 PM Eastern Daylight Time	08/04/2022 05:45:58 PM Eastern Daylight Time	08/03/2022 05:04:05 PM Eastern Daylight Time			08/05/2022 06:42:07 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	2023	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	7d;16b;17a;18a;	
H5434	031	0	1	04	01	H5434_031_0	7	1					1	08/03/2022	2023.01	08/03/2022 04:22:42 PM Eastern Daylight Time	08/04/2022 05:46:31 PM Eastern Daylight Time	08/03/2022 05:08:35 PM Eastern Daylight Time			08/05/2022 06:42:07 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	2023	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	7d;16b;17a;18a;	
H5434	032	0	1	04	01	H5434_032_0	6	1					1	08/03/2022	2023.01	08/03/2022 04:31:34 PM Eastern Daylight Time	08/04/2022 05:47:03 PM Eastern Daylight Time	08/03/2022 05:13:26 PM Eastern Daylight Time			08/05/2022 06:42:07 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	2023	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	7d;16b;17a;18a;	
H5434	033	0	1	04	01	H5434_033_0	6	1					1	08/03/2022	2023.01	08/03/2022 04:34:04 PM Eastern Daylight Time	08/04/2022 05:47:35 PM Eastern Daylight Time	08/03/2022 05:18:07 PM Eastern Daylight Time			08/05/2022 07:10:32 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	2023	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	7d;16b;17a;18a;	
H5434	034	0	1	04	01	H5434_034_0	6	1					1	08/03/2022	2023.01	08/03/2022 04:36:34 PM Eastern Daylight Time	08/04/2022 05:48:08 PM Eastern Daylight Time	08/03/2022 05:22:58 PM Eastern Daylight Time			08/05/2022 07:10:32 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	2023	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	7d;16b;17a;18a;	
H5434	035	0	1	04	01	H5434_035_0	5	1					1	08/03/2022	2023.01	08/03/2022 04:39:00 PM Eastern Daylight Time	08/04/2022 05:48:40 PM Eastern Daylight Time	08/03/2022 05:27:54 PM Eastern Daylight Time			08/05/2022 07:10:32 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	2023	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	7d;16b;17a;18a;	
H5434	036	0	1	04	01	H5434_036_0	5	1					1	08/03/2022	2023.01	08/03/2022 04:41:27 PM Eastern Daylight Time	08/04/2022 05:49:14 PM Eastern Daylight Time	08/03/2022 05:33:06 PM Eastern Daylight Time			08/05/2022 07:10:32 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	2023	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	7d;16b;17a;18a;	
H5434	038	0	1	04	01	H5434_038_0	4	1				0	0	06/01/2022	2023.01	06/01/2022 02:31:10 PM Eastern Daylight Time	06/06/2022 07:50:24 PM Eastern Daylight Time				06/06/2022 08:28:55 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	2023	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	4	1					1	08/03/2022	2023.01	08/03/2022 04:45:05 PM Eastern Daylight Time	08/04/2022 05:49:46 PM Eastern Daylight Time	08/03/2022 05:38:27 PM Eastern Daylight Time			08/05/2022 07:10:32 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	2023	Alachua and 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	4	1				0	0	06/01/2022	2023.01	06/01/2022 02:31:30 PM Eastern Daylight Time	06/06/2022 07:51:37 PM Eastern Daylight Time				06/06/2022 08:28:55 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	2023	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	3	1				0	0	06/01/2022	2023.01	06/01/2022 02:31:54 PM Eastern Daylight Time	06/06/2022 07:52:10 PM Eastern Daylight Time				06/06/2022 08:28:55 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	2023	Clay, Duval, Nassau and 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	3	1				0	0	06/01/2022	2023.01	06/01/2022 02:32:15 PM Eastern Daylight Time	06/06/2022 07:52:45 PM Eastern Daylight Time				06/06/2022 08:28:55 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	2023	Hillsborough, Pasco and 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	3	1				0	0	06/01/2022	2023.01	06/01/2022 02:32:37 PM Eastern Daylight Time	06/06/2022 07:53:20 PM Eastern Daylight Time				06/06/2022 08:28:55 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	2023	Brevard and 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						06/06/2022	2023.01	06/06/2022 02:08:21 PM Eastern Daylight Time					06/06/2022 08:50:17 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	2023	State of Florida with National Coverage		1	38269	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						06/06/2022	2023.01	06/06/2022 02:12:46 PM Eastern Daylight Time					06/06/2022 08:50:17 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	2023	State of Florida with National Coverage		1	5806	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		2									
H5435	001	0	1	09	04	H5435_001_0	1	1				0	0	06/02/2022	2023.01	06/02/2022 08:56:41 AM Central Daylight Time	06/01/2022 09:58:53 AM Central Daylight Time				06/02/2022 01:13:21 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Patriot (PFFS)	04	09	2	1			H5435	001	0	2023	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						08/02/2022	2023.01	08/02/2022 10:28:36 AM Central Daylight Time	08/03/2022 11:17:02 AM Central Daylight Time	07/31/2022 03:30:26 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Rx (PFFS)	04	09	2	1			H5435	024	0	2023	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	3	1				0	0	07/14/2022	2023.01	07/14/2022 10:22:24 AM Eastern Daylight Time	06/03/2022 06:44:26 PM Central Daylight Time				07/15/2022 04:24:29 PM Central 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	2023	Select counties in OR and WA		2		2			2									www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5439	011	0	1	04	01	H5439_011_0	4	1						08/04/2022	2023.01	08/04/2022 12:46:01 PM Eastern Daylight Time	08/03/2022 07:33:14 PM Eastern Daylight Time	07/30/2022 09:39:17 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in OR and WA		2		2			2									www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	015	0	1	04	01	H5439_015_0	4	1						05/26/2022	2023.01	05/26/2022 12:41:43 PM Eastern Daylight Time	08/03/2022 07:34:46 PM Eastern Daylight Time	07/30/2022 09:39:48 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in OR and WA		2		2			2									www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	017	0	1	04	01	H5439_017_0	4	1						08/03/2022	2023.01	08/03/2022 03:16:32 PM Eastern Daylight Time	08/03/2022 07:36:15 PM Eastern Daylight Time	07/30/2022 09:40:19 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in OR		2		2			2									www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	018	0	1	04	01	H5439_018_0	4	1						08/03/2022	2023.01	08/03/2022 03:20:16 PM Eastern Daylight Time	08/03/2022 07:37:45 PM Eastern Daylight Time	07/30/2022 09:40:51 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in OR and WA		2		2			2									www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	019	0	1	04	01	H5439_019_0	5	1						08/02/2022	2023.01	08/02/2022 10:33:50 AM Eastern Daylight Time	08/03/2022 07:39:17 PM Eastern Daylight Time	07/30/2022 09:41:22 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in OR		2		2			2									www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	801	0	1	04	01	H5439_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:17:33 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:17:38 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:17:42 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:17:51 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:17:58 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	4	1					1	08/03/2022	2023.01	08/03/2022 03:31:12 PM Central Daylight Time	08/03/2022 03:43:56 PM Central Daylight Time	08/03/2022 03:49:57 PM Central Daylight Time			08/05/2022 05:48:10 PM Central Daylight Time	COMMUNITY FIRST HEALTH PLANS, INC.	Community First Health Plans	http://CommunityFirstMedicare.com	Community First Medicare Advantage Alamo Plan (HMO)	01	01		1			H5447	001	0	2023	Bexar County		2		2			2									http://CommunityFirstMedicare.com	http://CommunityFirstMedicare.com	http://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	5	1	2	1			0	08/03/2022	2023.01	08/03/2022 03:32:01 PM Central Daylight Time	08/03/2022 03:46:55 PM Central Daylight Time	08/03/2022 03:51:52 PM Central Daylight Time			08/05/2022 05:48:10 PM Central Daylight Time	COMMUNITY FIRST HEALTH PLANS, INC.	Community First Health Plans	http://CommunityFirstMedicare.com	Community First Medicare Advantage D-SNP (HMO D-SNP)	01	01		1			H5447	002	0	2023	South Texas		2		2			1	3		1					1	http://CommunityFirstMedicare.com	http://CommunityFirstMedicare.com	http://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	08/03/2022	2023.01	08/03/2022 07:54:30 AM Central Daylight Time	08/04/2022 03:28:44 PM Central Daylight Time	08/04/2022 03:37:16 PM Central Daylight Time			08/04/2022 04:25:51 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	2023	Rockford, Metro St Louis		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			
H5454	002	0	1	01	01	H5454_002_0	5	1					1	08/03/2022	2023.01	08/03/2022 07:55:20 AM Central Daylight Time	08/04/2022 03:29:21 PM Central Daylight Time	08/04/2022 03:37:45 PM Central Daylight Time			08/04/2022 04:25:51 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	2023	Metro Chicago		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			
H5471	064	0	1	01	01	H5471_064_0	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 09:50:14 AM Eastern Daylight Time	08/04/2022 06:21:50 PM Eastern Daylight Time	08/04/2022 06:39:40 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	6	1			2		0	08/01/2022	2023.01	08/01/2022 02:27:55 PM Eastern Daylight Time	08/04/2022 06:21:51 PM Eastern Daylight Time	08/04/2022 06:39:43 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply More (HMO)	01	01		1			H5471	065	0	2023	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	05/31/2022	2023.01	05/31/2022 10:11:54 AM Eastern Daylight Time	08/04/2022 06:21:53 PM Eastern Daylight Time	08/04/2022 06:39:46 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	06/02/2022	2023.01	06/02/2022 07:14:44 PM Eastern Daylight Time	08/04/2022 06:21:54 PM Eastern Daylight Time	08/04/2022 06:39:49 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	6	1		1	2		0	08/01/2022	2023.01	08/01/2022 02:28:44 PM Eastern Daylight Time	08/04/2022 06:21:55 PM Eastern Daylight Time	08/04/2022 06:39:51 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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		1	05/26/2022	2023.01	05/26/2022 12:19:28 PM Eastern Daylight Time	08/04/2022 06:21:57 PM Eastern Daylight Time	08/04/2022 06:39:54 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	Miami-Dade		2		2			1	4			00000000000000000010000					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		1	05/26/2022	2023.01	05/26/2022 12:19:48 PM Eastern Daylight Time	08/04/2022 06:21:58 PM Eastern Daylight Time	08/04/2022 06:39:56 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	Polk		2		2			1	4			00000000000000000010000					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	05/26/2022	2023.01	05/26/2022 12:20:27 PM Eastern Daylight Time	08/04/2022 06:21:59 PM Eastern Daylight Time	08/04/2022 06:39:59 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	05/31/2022	2023.01	05/31/2022 10:24:09 AM Eastern Daylight Time	08/04/2022 06:22:01 PM Eastern Daylight Time	08/04/2022 06:40:02 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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		1	05/26/2022	2023.01	05/26/2022 12:21:10 PM Eastern Daylight Time	08/04/2022 06:22:02 PM Eastern Daylight Time	08/04/2022 06:40:05 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	Orange, Osceola, Seminole		2		2			1	4			00000000000000000010000					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	05/26/2022	2023.01	05/26/2022 12:21:33 PM Eastern Daylight Time	08/04/2022 06:22:03 PM Eastern Daylight Time	08/04/2022 06:40:07 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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		1	07/11/2022	2023.01	07/11/2022 11:27:36 AM Eastern Daylight Time	08/04/2022 06:22:05 PM Eastern Daylight Time	08/04/2022 06:40:10 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	Hernando, Hillsborough, Pasco, Pinellas		2		2			1	4			00000000000000000010000					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	05/31/2022	2023.01	05/31/2022 10:26:27 AM Eastern Daylight Time	08/04/2022 06:22:06 PM Eastern Daylight Time	08/04/2022 06:40:13 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	08/01/2022	2023.01	08/01/2022 02:29:41 PM Eastern Daylight Time	08/04/2022 06:22:07 PM Eastern Daylight Time	08/04/2022 06:40:15 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	05/26/2022	2023.01	05/26/2022 12:22:45 PM Eastern Daylight Time	08/04/2022 06:22:09 PM Eastern Daylight Time	08/04/2022 06:40:18 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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		1	05/26/2022	2023.01	05/26/2022 12:23:15 PM Eastern Daylight Time	08/04/2022 06:22:10 PM Eastern Daylight Time	08/04/2022 06:40:21 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	Broward		2		2			1	4			00000000000000000010000					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	05/31/2022	2023.01	05/31/2022 10:28:00 AM Eastern Daylight Time	08/04/2022 06:22:12 PM Eastern Daylight Time	08/04/2022 06:40:23 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	08/01/2022	2023.01	08/01/2022 02:30:30 PM Eastern Daylight Time	08/04/2022 06:22:13 PM Eastern Daylight Time	08/04/2022 06:40:26 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	08/01/2022	2023.01	08/01/2022 02:31:33 PM Eastern Daylight Time	08/04/2022 06:22:14 PM Eastern Daylight Time	08/04/2022 06:40:29 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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		1	05/26/2022	2023.01	05/26/2022 12:26:20 PM Eastern Daylight Time	08/04/2022 06:22:16 PM Eastern Daylight Time	08/04/2022 06:40:31 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	Palm Beach		2		2			1	4			00000000000000000010000					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	06/02/2022	2023.01	06/02/2022 07:15:45 PM Eastern Daylight Time	08/04/2022 06:22:17 PM Eastern Daylight Time	08/04/2022 06:40:34 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	8	1		1	2		0	08/01/2022	2023.01	08/01/2022 02:32:33 PM Eastern Daylight Time	08/04/2022 06:22:19 PM Eastern Daylight Time	08/04/2022 06:40:37 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	05/13/2022	2023.01	05/13/2022 03:43:18 PM Eastern Daylight Time	08/04/2022 06:22:20 PM Eastern Daylight Time	08/04/2022 06:40:39 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	05/26/2022	2023.01	05/26/2022 12:26:52 PM Eastern Daylight Time	08/04/2022 06:22:22 PM Eastern Daylight Time	08/04/2022 06:40:42 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	08/01/2022	2023.01	08/01/2022 02:33:35 PM Eastern Daylight Time	08/04/2022 06:22:23 PM Eastern Daylight Time	08/04/2022 06:40:45 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	7	1			2		0	05/19/2022	2023.01	05/19/2022 04:42:25 PM Eastern Daylight Time	08/04/2022 06:22:24 PM Eastern Daylight Time	08/04/2022 06:40:47 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	05/13/2022	2023.01	05/13/2022 03:44:20 PM Eastern Daylight Time	08/04/2022 06:22:26 PM Eastern Daylight Time	08/04/2022 06:40:50 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	05/18/2022	2023.01	05/18/2022 06:56:19 PM Eastern Daylight Time	08/04/2022 06:22:27 PM Eastern Daylight Time	08/04/2022 06:40:53 PM Eastern Daylight Time			08/04/2022 07:22:32 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	2023	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	110	0	1	01	01	H5471_110_0	6	1			2		0	08/01/2022	2023.01	08/01/2022 04:18:14 PM Eastern Daylight Time	08/04/2022 06:22:28 PM Eastern Daylight Time	08/04/2022 06:40:55 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply More (HMO)	01	01		1			H5471	110	0	2023	Clay, Duval, St. Johns		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	111	0	1	01	01	H5471_111_0	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:37:34 AM Eastern Daylight Time	08/04/2022 06:22:30 PM Eastern Daylight Time	08/04/2022 06:40:58 PM Eastern Daylight Time			08/04/2022 07:22:32 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	111	0	2023	Clay, Duval, St. Johns		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	112	0	1	01	01	H5471_112_0	6	1			2		0	05/13/2022	2023.01	05/13/2022 03:45:21 PM Eastern Daylight Time	08/04/2022 06:22:31 PM Eastern Daylight Time	08/04/2022 06:41:01 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Extra (HMO)	01	01		1			H5471	112	0	2023	Clay, Duval, St. Johns		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			
H5472	001	0	1	01	01	H5472_001_0	5	1			1		0	08/05/2022	2023.01	08/05/2022 02:22:55 PM Pacific Daylight Time	08/05/2022 02:17:36 PM Pacific Daylight Time	08/02/2022 11:07:36 AM Pacific Daylight Time			08/05/2022 03:03:37 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health the ONE (HMO)	01	01		1			H5472	001	0	2023	El Paso & Hudspeth		2		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			
H5472	002	0	1	01	01	H5472_002_0	5	1		1	2		0	08/05/2022	2023.01	08/05/2022 02:35:26 PM Pacific Daylight Time	08/05/2022 02:17:40 PM Pacific Daylight Time	08/02/2022 02:27:50 PM Pacific Daylight Time			08/05/2022 03:03:37 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Heart & Diabetes (HMO C-SNP)	01	01		1			H5472	002	0	2023	El Paso & Hudspeth		2		2			1	4			00000000000000000010000					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			
H5472	801	0	1	01	01	H5472_801_0	2	1						06/04/2022	2023.01	06/04/2022 12:32:04 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H5472	801	0	2023	El Paso & Hudspeth		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			
H5472	802	0	1	01	01	H5472_802_0	2	1						06/04/2022	2023.01	06/04/2022 12:33:32 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H5472	802	0	2023	El Paso & Hudspeth		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			
H5472	803	0	1	01	01	H5472_803_0	2	1				0	0	06/04/2022	2023.01	06/04/2022 12:31:33 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H5472	803	0	2023	El Paso & Hudspeth		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			
H5472	804	0	1	01	01	H5472_804_0	2	1				0	0	06/04/2022	2023.01	06/04/2022 12:35:21 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H5472	804	0	2023	El Paso & Hudspeth		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			
H5475	001	0	1	02	01	H5475_001_0	7	1	2	1	1		0	07/11/2022	2023.01	07/11/2022 09:41:46 AM Eastern Daylight Time	08/03/2022 07:53:48 PM Eastern Daylight Time	07/30/2022 09:41:54 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in MI		2		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	6	1			2			08/01/2022	2023.01	08/01/2022 01:45:58 PM Eastern Daylight Time	08/03/2022 07:55:02 PM Eastern Daylight Time	07/30/2022 09:42:26 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	7	1	2	1	1		0	07/11/2022	2023.01	07/11/2022 09:47:28 AM Eastern Daylight Time	08/03/2022 07:56:16 PM Eastern Daylight Time	07/30/2022 09:43:00 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	6	1						08/01/2022	2023.01	08/01/2022 12:37:59 PM Eastern Daylight Time	08/03/2022 07:57:29 PM Eastern Daylight Time	07/30/2022 09:43:31 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	6	1			2			08/03/2022	2023.01	08/03/2022 03:41:50 PM Eastern Daylight Time	08/03/2022 07:58:44 PM Eastern Daylight Time	07/30/2022 09:44:02 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in MI		2		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	6	1			2			08/01/2022	2023.01	08/01/2022 02:44:31 PM Eastern Daylight Time	08/03/2022 07:59:59 PM Eastern Daylight Time	07/30/2022 09:44:33 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in MI		2		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	031	0	1	01	01	H5475_031_0	6	1			2			08/03/2022	2023.01	08/03/2022 03:43:04 PM Eastern Daylight Time	08/03/2022 08:01:13 PM Eastern Daylight Time	07/30/2022 09:45:05 AM Eastern Daylight Time			08/04/2022 05:16:49 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H5475	031	0	2023	Select counties in MI		2		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	6	1						08/03/2022	2023.01	08/03/2022 03:44:03 PM Eastern Daylight Time	08/03/2022 08:02:29 PM Eastern Daylight Time	07/30/2022 09:45:37 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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	7	1			2			05/26/2022	2023.01	05/26/2022 08:52:29 AM Eastern Daylight Time	08/03/2022 08:03:45 PM Eastern Daylight Time	07/30/2022 09:46:08 AM Eastern Daylight Time			08/04/2022 05:16:49 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H5475	038	0	2023	Select counties in MI		2		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	1	1						05/31/2022	2023.01	05/31/2022 09:53:18 AM Eastern Daylight Time		05/31/2022 09:46:21 AM Eastern Daylight Time			05/31/2022 09:55:17 AM 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	2023	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	1	1						05/31/2022	2023.01	05/31/2022 09:53:32 AM Eastern Daylight Time		05/31/2022 09:46:56 AM Eastern Daylight Time			05/31/2022 09:55:17 AM 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	2023	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	08/04/2022	2023.01	08/04/2022 03:39:14 PM Eastern Daylight Time	08/04/2022 03:49:28 PM Eastern Daylight Time	08/04/2022 02:23:44 PM Eastern Daylight Time			08/05/2022 09:39:28 AM Eastern 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	2023	Northern, Central and Southern California		2		2			1	4			00000000000000000010000					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	08/04/2022	2023.01	08/04/2022 03:40:09 PM Eastern Daylight Time	08/04/2022 03:49:50 PM Eastern Daylight Time	08/04/2022 02:24:32 PM Eastern Daylight Time			08/05/2022 09:39:28 AM Eastern Daylight Time	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Imperial Health Plan of California, Inc.	www.imperialhealthplan.com	Imperial Traditional (HMO)	01	01		1			H5496	007	0	2023	Northern, Central and Southern California		2		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	9	1	2	1			0	08/18/2022	2023.01	08/18/2022 10:37:39 AM Eastern Daylight Time	08/17/2022 02:56:56 PM Eastern Daylight Time	08/17/2022 02:51:36 PM Eastern Daylight Time			08/18/2022 12:06:39 PM Eastern 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	2023	Northern, Central and Southern California		2		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	08/04/2022	2023.01	08/04/2022 03:40:22 PM Eastern Daylight Time	08/04/2022 03:50:36 PM Eastern Daylight Time	08/04/2022 02:25:41 PM Eastern Daylight Time			08/05/2022 09:39:28 AM Eastern 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	2023	Northern, Central, Southern California		2		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	08/04/2022	2023.01	08/04/2022 03:40:59 PM Eastern Daylight Time	08/04/2022 03:50:59 PM Eastern Daylight Time	08/04/2022 02:26:18 PM Eastern Daylight Time			08/05/2022 09:39:28 AM Eastern 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	2023	Northern, Central and Southern California		2		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			
H5496	016	0	1	01	01	H5496_016_0	7	1				0	0	07/13/2022	2023.01	07/13/2022 12:28:01 PM Eastern Daylight Time	06/06/2022 05:42:40 PM Eastern Daylight Time				07/13/2022 12:40:14 PM Eastern Daylight Time	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Imperial Health Plan of California, Inc.	www.imperialhealthplan.com	Imperial Courage Plan (HMO)	01	01		1			H5496	016	0	2023	Northern, Central, Southern California		2		2			2									www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5521	013	0	1	04	01	H5521_013_0	3	1			2		0	06/06/2022	2023.01	06/06/2022 11:57:06 AM Eastern Daylight Time	08/02/2022 01:30:45 PM Eastern Daylight Time	07/31/2022 11:18:20 PM Eastern Daylight Time			08/04/2022 06:13:42 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	2023	Connecticut		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		(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	5	1			2		0	05/31/2022	2023.01	05/31/2022 07:40:08 PM Eastern Daylight Time	08/02/2022 01:20:17 PM Eastern Daylight Time	07/31/2022 11:18:46 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	015	0	2023	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		(888)268-9800		(888)268-9800		(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	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:08:59 PM Eastern Daylight Time	08/03/2022 03:01:24 PM Eastern Daylight Time	07/31/2022 11:19:12 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	016	0	2023	IL Chicago		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	020	0	1	04	01	H5521_020_0	5	1			2		0	05/31/2022	2023.01	05/31/2022 08:19:29 PM Eastern Daylight Time	08/03/2022 08:39:22 AM Eastern Daylight Time	07/31/2022 11:19:38 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 2 (PPO)	01	04		1			H5521	020	0	2023	Select Counties in OH & KY		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		(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	4	1			2		0	07/15/2022	2023.01	07/15/2022 02:13:51 PM Eastern Daylight Time	08/02/2022 02:45:21 PM Eastern Daylight Time	07/31/2022 11:20:04 PM Eastern Daylight Time			08/05/2022 10:16:12 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	022	0	2023	Clark and Nye Counties		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	027	0	1	04	01	H5521_027_0	6	1			2		0	08/03/2022	2023.01	08/03/2022 10:33:51 AM Eastern Daylight Time	08/02/2022 01:21:09 PM Eastern Daylight Time	07/31/2022 11:20:30 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	027	0	2023	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		(888)268-9800		(888)268-9800		(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			2		0	08/02/2022	2023.01	08/02/2022 03:34:47 PM Eastern Daylight Time	08/03/2022 03:19:10 PM Eastern Daylight Time	07/31/2022 11:20:56 PM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	033	0	2023	North, Central, West, NW, SW, TC, South FL		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	037	0	1	04	01	H5521_037_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 05:52:56 PM Central Daylight Time	08/02/2022 04:04:39 PM Central Daylight Time	07/31/2022 10:21:22 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier (PPO)	01	04		1			H5521	037	0	2023	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	(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	040	0	1	04	01	H5521_040_0	3	1			2		0	06/06/2022	2023.01	06/06/2022 12:04:58 PM Eastern Daylight Time	08/02/2022 05:48:46 PM Eastern Daylight Time	07/31/2022 11:21:48 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	040	0	2023	Metro Area: NYC, Queens, Brooklyn, SI, Nassau		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	053	0	1	04	01	H5521_053_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 01:58:08 PM Eastern Daylight Time	08/02/2022 03:44:40 PM Eastern Daylight Time	07/31/2022 11:22:14 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	053	0	2023	San Diego County		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	055	0	1	04	01	H5521_055_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 06:02:06 PM Eastern Daylight Time	08/02/2022 02:46:23 PM Eastern Daylight Time	07/31/2022 11:22:42 PM Eastern Daylight Time			08/04/2022 06:27:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	055	0	2023	Clark and Nye Counties		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	056	0	1	04	01	H5521_056_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 01:58:20 PM Eastern Daylight Time	08/02/2022 03:45:39 PM Eastern Daylight Time	07/31/2022 11:23:08 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	056	0	2023	Orange County		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	2	1			2		0	05/27/2022	2023.01	05/27/2022 10:17:16 PM Eastern Daylight Time	08/02/2022 05:49:43 PM Eastern Daylight Time	07/31/2022 11:23:34 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	076	0	2023	Greater Rochester 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	077	0	1	04	01	H5521_077_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 02:58:36 PM Eastern Daylight Time	08/02/2022 05:50:41 PM Eastern Daylight Time	07/31/2022 11:24:00 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	077	0	2023	Northern Central Upstate New York		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	081	0	1	04	01	H5521_081_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 04:38:14 PM Eastern Daylight Time	08/02/2022 08:20:13 PM Eastern Daylight Time	07/31/2022 11:24:26 PM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	081	0	2023	North Carolina		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		(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	5	1			2		0	05/31/2022	2023.01	05/31/2022 07:41:48 PM Eastern Daylight Time	08/02/2022 01:22:02 PM Eastern Daylight Time	07/31/2022 11:24:52 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	082	0	2023	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		(888)268-9800		(888)268-9800		(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	5	1			2		0	05/31/2022	2023.01	05/31/2022 07:43:25 PM Eastern Daylight Time	08/02/2022 01:22:32 PM Eastern Daylight Time	07/31/2022 11:25:20 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	083	0	2023	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		(888)268-9800		(888)268-9800		(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	5	1			2		0	05/31/2022	2023.01	05/31/2022 07:45:57 PM Eastern Daylight Time	08/02/2022 01:24:11 PM Eastern Daylight Time	07/31/2022 11:25:46 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	084	0	2023	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		(888)268-9800		(888)268-9800		(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	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:19:15 AM Eastern Daylight Time	08/03/2022 08:40:19 AM Eastern Daylight Time	07/31/2022 11:26:12 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	085	0	2023	Northern Kentucky 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		(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	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:00:41 PM Eastern Daylight Time	08/03/2022 03:02:18 PM Eastern Daylight Time	07/31/2022 11:26:38 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	086	0	2023	IL Chicago		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	087	0	1	04	01	H5521_087_0	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:35:37 AM Eastern Daylight Time	08/03/2022 08:41:13 AM Eastern Daylight Time	07/31/2022 11:27:04 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	087	0	2023	Cincinnati 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		(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	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:22:58 AM Eastern Daylight Time	08/03/2022 08:42:10 AM Eastern Daylight Time	07/31/2022 11:27:30 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	088	0	2023	Cleveland and Toledo 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		(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	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:23:24 AM Eastern Daylight Time	08/03/2022 08:43:05 AM Eastern Daylight Time	07/31/2022 11:27:58 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	089	0	2023	Central Ohio 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		(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	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:23:59 AM Eastern Daylight Time	08/03/2022 08:44:00 AM Eastern Daylight Time	07/31/2022 11:28:24 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	090	0	2023	Dayton 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		(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	2	1			2		1	08/02/2022	2023.01	08/02/2022 06:20:01 PM Eastern Daylight Time	08/03/2022 01:09:32 PM Eastern Daylight Time	07/31/2022 11:28:50 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	091	0	2023	Atlanta GA and Southeast AL 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	095	0	1	04	01	H5521_095_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 12:48:49 PM Eastern Daylight Time	08/03/2022 01:10:14 PM Eastern Daylight Time	07/31/2022 11:29:16 PM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	095	0	2023	New Castle, Kent and Sussex Counties		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	099	0	1	04	01	H5521_099_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:39:38 AM Eastern Daylight Time	08/03/2022 03:03:13 PM Eastern Daylight Time	07/31/2022 11:29:44 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	099	0	2023	IN Northeast		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	100	0	1	04	01	H5521_100_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:48:07 PM Eastern Daylight Time	08/02/2022 02:14:43 PM Eastern Daylight Time	07/31/2022 11:30:08 PM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	100	0	2023	Maricopa, Pima and Pinal Counties		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	101	0	1	04	01	H5521_101_0	3	1			2		0	07/15/2022	2023.01	07/15/2022 02:14:59 PM Eastern Daylight Time	08/02/2022 02:47:30 PM Eastern Daylight Time	07/31/2022 11:30:34 PM Eastern Daylight Time			08/04/2022 06:27:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	101	0	2023	Davis, Salt Lake, Utah and Weber Counties		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	5	1			2		0	05/31/2022	2023.01	05/31/2022 07:47:37 PM Eastern Daylight Time	08/02/2022 01:24:08 PM Eastern Daylight Time	07/31/2022 11:31:00 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	102	0	2023	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		(888)268-9800		(888)268-9800		(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			2		0	05/31/2022	2023.01	05/31/2022 05:08:26 PM Eastern Daylight Time	08/02/2022 05:51:39 PM Eastern Daylight Time	08/05/2022 10:09:40 AM Eastern Daylight Time			08/05/2022 11:35:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	110	0	2023	Capital Region and Hudson Valley 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	116	0	1	04	01	H5521_116_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 09:31:34 PM Eastern Daylight Time	08/03/2022 01:10:35 PM Eastern Daylight Time	07/31/2022 11:31:54 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	116	0	2023	Southwest Alabama		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	117	0	1	04	01	H5521_117_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 07:28:49 PM Eastern Daylight Time	08/02/2022 05:52:34 PM Eastern Daylight Time	07/31/2022 11:32:20 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	117	0	2023	Suffolk County		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	118	0	1	04	01	H5521_118_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:49:47 PM Eastern Daylight Time	08/02/2022 05:53:30 PM Eastern Daylight Time	07/31/2022 11:32:46 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	118	0	2023	Greater Rochester 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	119	0	1	04	01	H5521_119_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 01:50:46 PM Eastern Daylight Time	08/02/2022 05:54:27 PM Eastern Daylight Time	07/31/2022 11:33:12 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	119	0	2023	Capital Region and Hudson Valley 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	120	0	1	04	01	H5521_120_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 01:54:07 PM Eastern Daylight Time	08/02/2022 05:55:25 PM Eastern Daylight Time	07/31/2022 11:33:38 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	120	0	2023	Metro Area: LI, 5 Boroughs, Westchester/Rockland		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	121	0	1	04	01	H5521_121_0	2	1			2		0	05/27/2022	2023.01	05/27/2022 10:51:41 PM Eastern Daylight Time	08/02/2022 05:56:21 PM Eastern Daylight Time	07/31/2022 11:34:04 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	121	0	2023	Westchester, Rockland, Bronx Counties		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	122	0	1	04	01	H5521_122_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 12:50:24 PM Eastern Daylight Time	08/03/2022 01:12:11 PM Eastern Daylight Time	07/31/2022 11:34:30 PM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Gold Plan (PPO)	01	04		1			H5521	122	0	2023	Pennsylvania		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	123	0	1	04	01	H5521_123_0	2	1			2		0	05/26/2022	2023.01	05/26/2022 12:19:59 PM Eastern Daylight Time	08/02/2022 04:05:32 PM Central Daylight Time	07/31/2022 10:34:56 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare SNJ Prime Elite (PPO)	01	04		1			H5521	123	0	2023	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	(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	124	0	1	04	01	H5521_124_0	2	1			2		0	05/26/2022	2023.01	05/26/2022 12:21:40 PM Eastern Daylight Time	08/02/2022 04:06:26 PM Central Daylight Time	07/31/2022 10:35:24 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier 2 (PPO)	01	04		1			H5521	124	0	2023	SNJ Counties: ATL, BUR, CAM, CPM, CUM, GLO, SLM		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	125	0	1	04	01	H5521_125_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 01:58:34 PM Eastern Daylight Time	08/02/2022 03:46:48 PM Eastern Daylight Time	07/31/2022 11:35:50 PM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	125	0	2023	Los Angeles County		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	127	0	1	04	01	H5521_127_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 03:06:51 PM Eastern Daylight Time	08/02/2022 03:27:34 PM Eastern Daylight Time	07/31/2022 11:36:16 PM Eastern Daylight Time			08/10/2022 03:45:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	127	0	2023	Puget Sound 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	128	0	1	04	01	H5521_128_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 03:07:18 PM Eastern Daylight Time	08/02/2022 03:28:41 PM Eastern Daylight Time	07/31/2022 11:36:42 PM Eastern Daylight Time			08/10/2022 03:45:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	128	0	2023	Puget Sound 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	134	0	1	04	01	H5521_134_0	5	1			2		0	05/31/2022	2023.01	05/31/2022 07:49:11 PM Eastern Daylight Time	08/03/2022 08:44:56 AM Eastern Daylight Time	07/31/2022 11:37:08 PM Eastern Daylight Time			08/05/2022 11:54:42 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 1 (PPO)	01	04		1			H5521	134	0	2023	Select Counties in Ohio		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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			2		0	08/10/2022	2023.01	08/10/2022 04:37:44 PM Eastern Daylight Time	08/02/2022 08:21:13 PM Eastern Daylight Time	07/31/2022 11:37:34 PM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	139	0	2023	North Carolina		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		(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	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:18:23 PM Eastern Daylight Time	08/02/2022 08:22:11 PM Eastern Daylight Time	07/31/2022 11:38:00 PM Eastern Daylight Time			08/04/2022 06:02:41 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	140	0	2023	Greenville/Spartanburg SC 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		(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	3	1			2		0	08/10/2022	2023.01	08/10/2022 04:37:16 PM Eastern Daylight Time	08/02/2022 08:23:11 PM Eastern Daylight Time	07/31/2022 11:38:28 PM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	141	0	2023	Nashville TN 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		(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	2	1			2		1	05/31/2022	2023.01	05/31/2022 12:16:34 PM Eastern Daylight Time	08/02/2022 03:42:07 PM Eastern Daylight Time	07/31/2022 11:38:54 PM Eastern Daylight Time			08/04/2022 06:13:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	144	0	2023	Maine		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		(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	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:12:13 PM Eastern Daylight Time	08/03/2022 03:04:09 PM Eastern Daylight Time	07/31/2022 11:39:20 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	150	0	2023	WI Southeast		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	154	0	1	04	01	H5521_154_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 04:36:47 PM Eastern Daylight Time	08/02/2022 08:24:11 PM Eastern Daylight Time	07/31/2022 11:39:46 PM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	154	0	2023	Memphis TN 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		(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	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:26:43 AM Eastern Daylight Time	08/03/2022 08:45:51 AM Eastern Daylight Time	07/31/2022 11:40:12 PM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	156	0	2023	Lexington 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		(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			2		0	08/01/2022	2023.01	08/01/2022 06:48:37 PM Eastern Daylight Time	08/02/2022 01:32:35 PM Eastern Daylight Time	07/31/2022 11:40:38 PM Eastern Daylight Time			08/04/2022 06:13:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	157	0	2023	Connecticut		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		(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	2	1			2		0	08/01/2022	2023.01	08/01/2022 06:50:31 PM Eastern Daylight Time	08/02/2022 01:33:30 PM Eastern Daylight Time	07/31/2022 11:41:06 PM Eastern Daylight Time			08/04/2022 06:13:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	159	0	2023	Eastern Massachusetts		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		(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	2	1			2		0	08/01/2022	2023.01	08/01/2022 06:50:52 PM Eastern Daylight Time	08/02/2022 01:34:25 PM Eastern Daylight Time	07/31/2022 11:41:32 PM Eastern Daylight Time			08/04/2022 06:13:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	160	0	2023	Central Massachusetts		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		(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			2		0	08/10/2022	2023.01	08/10/2022 04:36:12 PM Eastern Daylight Time	08/02/2022 08:25:11 PM Eastern Daylight Time	07/31/2022 11:41:58 PM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	168	0	2023	Wake and Durham Counties NC		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		(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	2	1			1		0	08/02/2022	2023.01	08/02/2022 02:02:55 PM Eastern Daylight Time	08/02/2022 08:26:12 PM Eastern Daylight Time	07/31/2022 11:42:24 PM Eastern Daylight Time			08/04/2022 06:02:41 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	169	0	2023	Sandhills and Southeastern NC		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		(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	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:26:04 PM Eastern Daylight Time	08/02/2022 08:27:14 PM Eastern Daylight Time	07/31/2022 11:42:50 PM Eastern Daylight Time			08/04/2022 06:02:41 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	2023	North Carolina		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		(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	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:22:30 PM Eastern Daylight Time	08/03/2022 01:11:36 PM Eastern Daylight Time	07/31/2022 11:43:18 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	171	0	2023	Central Alabama		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	177	0	1	04	01	H5521_177_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 06:24:13 PM Eastern Daylight Time	08/03/2022 01:12:45 PM Eastern Daylight Time	07/31/2022 11:43:44 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	177	0	2023	Cherokee County		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	178	0	1	04	01	H5521_178_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 06:26:08 PM Eastern Daylight Time	08/03/2022 01:13:56 PM Eastern Daylight Time	07/31/2022 11:44:10 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	178	0	2023	Select Louisiana Parishes		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	184	0	1	04	01	H5521_184_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:48:22 PM Eastern Daylight Time	08/02/2022 02:15:54 PM Eastern Daylight Time	07/31/2022 11:44:38 PM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	01	04		1			H5521	184	0	2023	Maricopa, Pima and Pinal Counties		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	190	0	1	04	01	H5521_190_0	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:22:24 PM Eastern Daylight Time	08/03/2022 03:05:03 PM Eastern Daylight Time	07/31/2022 11:45:10 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	190	0	2023	IN Northeast		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	194	0	1	04	01	H5521_194_0	4	1			2		0	08/02/2022	2023.01	08/02/2022 10:54:40 AM Eastern Daylight Time	08/03/2022 03:05:57 PM Eastern Daylight Time	07/31/2022 11:45:36 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	194	0	2023	MI Southwest		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	195	0	1	04	01	H5521_195_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:01:15 PM Eastern Daylight Time	08/03/2022 03:06:50 PM Eastern Daylight Time	07/31/2022 11:46:02 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	195	0	2023	WI Southeast		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	196	0	1	04	01	H5521_196_0	3	1			2		0	05/31/2022	2023.01	05/31/2022 06:56:57 PM Eastern Daylight Time	08/02/2022 02:49:23 PM Eastern Daylight Time	07/31/2022 11:46:28 PM Eastern Daylight Time			08/05/2022 10:16:12 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	196	0	2023	Iron and Washington Counties		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	197	0	1	04	01	H5521_197_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 06:58:00 PM Eastern Daylight Time	08/02/2022 02:50:24 PM Eastern Daylight Time	07/31/2022 11:46:56 PM Eastern Daylight Time			08/04/2022 06:27:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	197	0	2023	Northern Utah Rural and Southwest Wyoming		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	200	0	1	04	01	H5521_200_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:48:37 PM Eastern Daylight Time	08/02/2022 02:17:02 PM Eastern Daylight Time	07/31/2022 11:47:22 PM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	01	04		1			H5521	200	0	2023	Counties COH, COC, GIL, GRA, MOH, SC, YAV, YUM		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	207	0	1	04	01	H5521_207_0	2	1						08/01/2022	2023.01	08/01/2022 01:10:04 PM Central Daylight Time	08/02/2022 12:58:31 PM Central Daylight Time	07/31/2022 10:47:48 PM Central Daylight Time			08/04/2022 09:41:18 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus 2 (PPO)	01	04		1			H5521	207	0	2023	Southern & Western Colorado		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	211	0	1	04	01	H5521_211_0	3	1			1		0	08/02/2022	2023.01	08/02/2022 10:42:05 AM Eastern Daylight Time	08/03/2022 03:07:45 PM Eastern Daylight Time	07/31/2022 11:48:14 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	211	0	2023	IN Southwest		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	214	0	1	04	01	H5521_214_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:42:33 AM Eastern Daylight Time	08/03/2022 03:08:39 PM Eastern Daylight Time	07/31/2022 11:48:40 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	214	0	2023	MI Southeast		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	215	0	1	04	01	H5521_215_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 10:01:27 PM Eastern Daylight Time	08/02/2022 05:57:17 PM Eastern Daylight Time	07/31/2022 11:49:06 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	215	0	2023	Western New York		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	216	0	1	04	01	H5521_216_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:27:11 PM Eastern Daylight Time	08/03/2022 01:15:11 PM Eastern Daylight Time	07/31/2022 11:49:32 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	216	0	2023	Tuscaloosa and Surrounding Counties		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	217	0	1	04	01	H5521_217_0	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:14:32 PM Eastern Daylight Time	08/03/2022 03:09:32 PM Eastern Daylight Time	07/31/2022 11:49:58 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	217	0	2023	MI Southeast		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	218	0	1	04	01	H5521_218_0	4	1			2		1	08/10/2022	2023.01	08/10/2022 03:18:40 PM Eastern Daylight Time	08/03/2022 01:16:29 PM Eastern Daylight Time	07/31/2022 11:50:24 PM Eastern Daylight Time			08/10/2022 03:26:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	218	0	2023	Northern Mississippi		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	219	0	1	04	01	H5521_219_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:44:26 AM Eastern Daylight Time	08/03/2022 03:10:26 PM Eastern Daylight Time	07/31/2022 11:50:50 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	219	0	2023	MI Southwest		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	220	0	1	04	01	H5521_220_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:28:46 PM Eastern Daylight Time	08/03/2022 01:17:32 PM Eastern Daylight Time	07/31/2022 11:51:16 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	220	0	2023	Southern Mississippi		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	222	0	1	04	01	H5521_222_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 09:32:23 PM Eastern Daylight Time	08/03/2022 01:18:38 PM Eastern Daylight Time	07/31/2022 11:51:44 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	222	0	2023	Southeast Alabama		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	223	0	1	04	01	H5521_223_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:03:02 PM Eastern Daylight Time	08/03/2022 03:11:20 PM Eastern Daylight Time	07/31/2022 11:52:10 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	223	0	2023	IN Northwest		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	224	0	1	04	01	H5521_224_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:31:31 PM Eastern Daylight Time	08/03/2022 01:19:55 PM Eastern Daylight Time	07/31/2022 11:52:36 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	224	0	2023	Montgomery and Surrounding Counties		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	226	0	1	04	01	H5521_226_0	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:16:38 PM Eastern Daylight Time	08/03/2022 03:12:15 PM Eastern Daylight Time	07/31/2022 11:53:02 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	226	0	2023	IN Northwest		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	227	0	1	04	01	H5521_227_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:32:19 PM Eastern Daylight Time	08/03/2022 01:21:03 PM Eastern Daylight Time	07/31/2022 11:53:28 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	227	0	2023	Northern Alabama		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	229	0	1	04	01	H5521_229_0	2	1			2	0	0	05/31/2022	2023.01	05/31/2022 08:56:05 PM Eastern Daylight Time	06/29/2022 01:54:15 PM Eastern Daylight Time				06/30/2022 02:09:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	229	0	2023	Select Alabama Counties		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	230	0	1	04	01	H5521_230_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:32:50 PM Eastern Daylight Time	08/03/2022 01:23:18 PM Eastern Daylight Time	07/31/2022 11:53:56 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	230	0	2023	Monroe Metro and Surrounding Parishes		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		(800)282-5366		(800)282-5366		(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			1		0	08/02/2022	2023.01	08/02/2022 10:47:07 AM Eastern Daylight Time	08/03/2022 03:13:11 PM Eastern Daylight Time	07/31/2022 11:54:22 PM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	231	0	2023	IN Central		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	232	0	1	04	01	H5521_232_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:34:02 PM Eastern Daylight Time	08/03/2022 01:24:23 PM Eastern Daylight Time	07/31/2022 11:54:48 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	232	0	2023	Alexandria Metro and Surrounding Parishes		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	233	0	1	04	01	H5521_233_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:35:24 PM Eastern Daylight Time	08/03/2022 01:25:25 PM Eastern Daylight Time	07/31/2022 11:55:16 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	233	0	2023	Lake Charles Metro and Surrounding Parishes		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	234	0	1	04	01	H5521_234_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 10:05:14 PM Eastern Daylight Time	08/03/2022 01:26:43 PM Eastern Daylight Time	07/31/2022 11:55:42 PM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	234	0	2023	Lafayette Metro and Surrounding Parishes		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	235	0	1	04	01	H5521_235_0	2	1			2	0	0	05/31/2022	2023.01	05/31/2022 06:49:39 PM Eastern Daylight Time	06/29/2022 01:58:50 PM Eastern Daylight Time				06/30/2022 02:09:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	235	0	2023	Select Louisiana Parishes		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	236	0	1	04	01	H5521_236_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:25:37 PM Eastern Daylight Time	08/02/2022 08:28:14 PM Eastern Daylight Time	07/31/2022 11:56:06 PM Eastern Daylight Time			08/04/2022 06:02:41 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	236	0	2023	Western North Carolina		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		(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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 02:26:13 PM Eastern Daylight Time	06/01/2022 02:19:53 PM Eastern Daylight Time				06/02/2022 11:58:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	241	0	2023	North Carolina		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	243	0	1	04	01	H5521_243_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:25:14 PM Eastern Daylight Time	08/02/2022 08:30:22 PM Eastern Daylight Time	07/31/2022 11:56:34 PM Eastern Daylight Time			08/04/2022 06:02:41 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	243	0	2023	Eastern North Carolina		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		(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			2		0	08/10/2022	2023.01	08/10/2022 04:35:17 PM Eastern Daylight Time	08/02/2022 08:31:22 PM Eastern Daylight Time	07/31/2022 11:57:00 PM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	245	0	2023	Midland and Surrounding Area South Carolina		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	3	1			2		0	08/02/2022	2023.01	08/02/2022 06:02:46 PM Eastern Daylight Time	08/02/2022 02:51:32 PM Eastern Daylight Time	07/31/2022 11:57:26 PM Eastern Daylight Time			08/04/2022 06:27:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	246	0	2023	Davis, Salt Lake, Utah and Weber Counties		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	247	0	1	04	01	H5521_247_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:24:46 PM Eastern Daylight Time	08/02/2022 08:32:22 PM Eastern Daylight Time	07/31/2022 11:57:54 PM Eastern Daylight Time			08/04/2022 06:02:41 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	247	0	2023	Charleston Metro and Hilton Head South Carolina		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		(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			2		0	08/10/2022	2023.01	08/10/2022 04:34:49 PM Eastern Daylight Time	08/02/2022 08:33:22 PM Eastern Daylight Time	07/31/2022 11:58:20 PM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	249	0	2023	Pee Dee South Carolina		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		(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						08/01/2022	2023.01	08/01/2022 01:10:27 PM Central Daylight Time	08/02/2022 12:59:19 PM Central Daylight Time	07/31/2022 10:58:46 PM Central Daylight Time			08/04/2022 09:41:18 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus 1 (PPO)	01	04		1			H5521	250	0	2023	Denver Metro & Northern Colorado		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	251	0	1	04	01	H5521_251_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 04:34:26 PM Eastern Daylight Time	08/02/2022 08:34:23 PM Eastern Daylight Time	07/31/2022 11:59:12 PM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	251	0	2023	Midlands South Carolina		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		(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	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:23:13 PM Eastern Daylight Time	08/02/2022 08:35:24 PM Eastern Daylight Time	07/31/2022 11:59:38 PM Eastern Daylight Time			08/04/2022 06:02:41 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	254	0	2023	Middle Tennessee		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		(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	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:27:16 AM Eastern Daylight Time	08/03/2022 08:46:45 AM Eastern Daylight Time	08/01/2022 12:00:04 AM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	259	0	2023	Louisville 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		(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	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:28:22 AM Eastern Daylight Time	08/03/2022 08:47:41 AM Eastern Daylight Time	08/01/2022 12:00:32 AM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	260	0	2023	Bowling Green/Southwest KY Area		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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			2		0	08/10/2022	2023.01	08/10/2022 02:44:44 PM Eastern Daylight Time	08/03/2022 01:13:22 PM Eastern Daylight Time	08/01/2022 12:00:58 AM Eastern Daylight Time			08/10/2022 03:19:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	261	0	2023	Western Pennsylvania		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	262	0	1	04	01	H5521_262_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:45:28 PM Eastern Daylight Time	08/03/2022 01:14:39 PM Eastern Daylight Time	08/01/2022 12:01:24 AM Eastern Daylight Time			08/10/2022 04:16:47 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	262	0	2023	New Castle, Kent and Sussex Counties		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	263	0	1	04	01	H5521_263_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 04:50:03 PM Eastern Daylight Time	08/03/2022 01:16:06 PM Eastern Daylight Time	08/01/2022 12:01:50 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	263	0	2023	Central and Eastern Pennsylvania		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	266	0	1	04	01	H5521_266_0	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:29:02 AM Eastern Daylight Time	08/03/2022 08:48:36 AM Eastern Daylight Time	08/01/2022 12:02:16 AM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	266	0	2023	Ashland 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		(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	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:29:43 AM Eastern Daylight Time	08/03/2022 08:49:31 AM Eastern Daylight Time	08/01/2022 12:02:44 AM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	267	0	2023	Eastern Kentucky 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		(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			2		0	08/10/2022	2023.01	08/10/2022 02:47:49 PM Eastern Daylight Time	08/03/2022 03:20:12 PM Eastern Daylight Time	08/01/2022 12:03:10 AM Eastern Daylight Time			08/10/2022 03:37:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	268	0	2023	Central FL		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	269	0	1	04	01	H5521_269_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:48:24 PM Eastern Daylight Time	08/03/2022 03:21:08 PM Eastern Daylight Time	08/01/2022 12:03:36 AM Eastern Daylight Time			08/10/2022 03:37:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	269	0	2023	North FL, Central FL		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	270	0	1	04	01	H5521_270_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:49:09 PM Eastern Daylight Time	08/03/2022 03:22:02 PM Eastern Daylight Time	08/01/2022 12:04:02 AM Eastern Daylight Time			08/10/2022 03:37:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	270	0	2023	West FL		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	271	0	1	04	01	H5521_271_0	2	1			2		0	08/03/2022	2023.01	08/03/2022 07:55:01 AM Eastern Daylight Time	08/03/2022 03:22:56 PM Eastern Daylight Time	08/01/2022 12:04:30 AM Eastern Daylight Time			08/04/2022 04:16:59 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	271	0	2023	Central FL, North FL		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	272	0	1	04	01	H5521_272_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:49:35 PM Eastern Daylight Time	08/03/2022 03:23:52 PM Eastern Daylight Time	08/01/2022 12:04:56 AM Eastern Daylight Time			08/10/2022 03:37:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	272	0	2023	Southwest FL		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	273	0	1	04	01	H5521_273_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:50:04 PM Eastern Daylight Time	08/03/2022 03:24:48 PM Eastern Daylight Time	08/01/2022 12:05:22 AM Eastern Daylight Time			08/10/2022 03:37:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	273	0	2023	South FL, Treasure Coast FL		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	275	0	1	04	01	H5521_275_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 11:18:09 AM Central Daylight Time	08/02/2022 04:07:20 PM Central Daylight Time	07/31/2022 11:05:48 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Premier (PPO)	01	04		1			H5521	275	0	2023	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	(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	277	0	1	04	01	H5521_277_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 02:54:45 PM Central Daylight Time	08/02/2022 04:08:14 PM Central Daylight Time	07/31/2022 11:06:14 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Credit (PPO)	01	04		1			H5521	277	0	2023	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	(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	278	0	1	04	01	H5521_278_0	2	1			2		0	05/26/2022	2023.01	05/26/2022 12:45:52 PM Eastern Daylight Time	08/02/2022 04:09:21 PM Central Daylight Time	07/31/2022 11:06:42 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plus (PPO)	01	04		1			H5521	278	0	2023	Northern and Southern NJ		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	279	0	1	04	01	H5521_279_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 02:35:31 PM Eastern Daylight Time	06/01/2022 02:32:10 PM Eastern Daylight Time				06/02/2022 11:58:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	279	0	2023	South Carolina		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	280	0	1	04	01	H5521_280_0	4	1			2		0	08/10/2022	2023.01	08/10/2022 04:34:03 PM Eastern Daylight Time	08/02/2022 08:37:28 PM Eastern Daylight Time	08/01/2022 12:07:08 AM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	280	0	2023	Chattanooga TN 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		(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	4	1			2		0	08/10/2022	2023.01	08/10/2022 04:33:33 PM Eastern Daylight Time	08/02/2022 08:38:28 PM Eastern Daylight Time	08/01/2022 12:07:34 AM Eastern Daylight Time			08/10/2022 05:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	281	0	2023	Chattanooga TN 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		(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	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:47:47 AM Eastern Daylight Time	08/03/2022 03:14:05 PM Eastern Daylight Time	08/01/2022 12:08:00 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	283	0	2023	WI Northeast		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	284	0	1	04	01	H5521_284_0	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:28:20 PM Eastern Daylight Time	08/03/2022 03:14:59 PM Eastern Daylight Time	08/01/2022 12:08:26 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	284	0	2023	MI Northern		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	285	0	1	04	01	H5521_285_0	3	1			1		0	08/02/2022	2023.01	08/02/2022 10:49:08 AM Eastern Daylight Time	08/03/2022 03:15:54 PM Eastern Daylight Time	08/01/2022 12:08:52 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	285	0	2023	MI Northern		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	286	0	1	04	01	H5521_286_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 08:07:04 PM Eastern Daylight Time	06/01/2022 01:54:26 PM Eastern Daylight Time				06/02/2022 12:32:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	286	0	2023	IL, IN, MI, WI		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	288	0	1	04	01	H5521_288_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:49:45 AM Eastern Daylight Time	08/03/2022 03:17:54 PM Eastern Daylight Time	08/01/2022 12:09:20 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	288	0	2023	MI Middle		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	289	0	1	04	01	H5521_289_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:50:34 AM Eastern Daylight Time	08/03/2022 03:18:48 PM Eastern Daylight Time	08/01/2022 12:09:46 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	289	0	2023	WI Southern		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	290	0	1	04	01	H5521_290_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:48:54 PM Eastern Daylight Time	08/02/2022 02:18:11 PM Eastern Daylight Time	08/01/2022 12:10:14 AM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	290	0	2023	Coconino, Mohave and Yavapai Counties		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	292	0	1	04	01	H5521_292_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 01:58:49 PM Eastern Daylight Time	08/02/2022 03:47:54 PM Eastern Daylight Time	08/01/2022 12:10:40 AM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	292	0	2023	Ventura County		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	293	0	1	04	01	H5521_293_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 01:59:03 PM Eastern Daylight Time	08/02/2022 03:48:50 PM Eastern Daylight Time	08/01/2022 12:11:06 AM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	293	0	2023	Northern California		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	294	0	1	04	01	H5521_294_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 04:52:07 PM Eastern Daylight Time	08/03/2022 01:17:17 PM Eastern Daylight Time	08/01/2022 12:11:32 AM Eastern Daylight Time			08/04/2022 05:04:50 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	2023	Allentown Metro 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	295	0	1	04	01	H5521_295_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 06:09:41 PM Central Daylight Time	08/02/2022 04:10:15 PM Central Daylight Time	07/31/2022 11:11:58 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Elite (PPO)	01	04		1			H5521	295	0	2023	NNJ West Counties: HUT, SOM, SUX, WAR		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	296	0	1	04	01	H5521_296_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 02:45:47 PM Eastern Daylight Time	06/01/2022 01:42:11 PM Eastern Daylight Time				06/02/2022 11:58:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	296	0	2023	Massachusetts		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	298	0	1	04	01	H5521_298_0	2	1			2		0	05/26/2022	2023.01	05/26/2022 01:22:38 PM Eastern Daylight Time	08/02/2022 04:11:10 PM Central Daylight Time	07/31/2022 11:12:24 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier (PPO)	01	04		1			H5521	298	0	2023	NNJ West Counties: HUT, SOM, SUX, WAR		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	299	0	1	04	01	H5521_299_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 06:03:20 PM Eastern Daylight Time	08/02/2022 02:52:33 PM Eastern Daylight Time	08/01/2022 12:12:52 AM Eastern Daylight Time			08/04/2022 06:27:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	299	0	2023	Clark and Nye Counties		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	300	0	1	04	01	H5521_300_0	3	1			2		0	05/31/2022	2023.01	05/31/2022 07:01:25 PM Eastern Daylight Time	08/02/2022 02:53:40 PM Eastern Daylight Time	08/01/2022 12:13:18 AM Eastern Daylight Time			08/05/2022 10:16:12 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	300	0	2023	Northern Nevada		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	301	0	1	04	01	H5521_301_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 06:03:46 PM Eastern Daylight Time	08/02/2022 02:54:57 PM Eastern Daylight Time	08/01/2022 12:13:44 AM Eastern Daylight Time			08/04/2022 06:27:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	301	0	2023	Northern Nevada		2		2			2									www.aetnamedicare.com/formulary	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	302	0	1	04	01	H5521_302_0	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:24:00 PM Eastern Daylight Time	08/03/2022 03:19:43 PM Eastern Daylight Time	08/01/2022 12:14:10 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	302	0	2023	IN Central		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	303	0	1	04	01	H5521_303_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 06:04:08 PM Eastern Daylight Time	08/02/2022 02:55:58 PM Eastern Daylight Time	08/01/2022 12:14:38 AM Eastern Daylight Time			08/04/2022 06:27:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	303	0	2023	Northern Nevada		2		2			2									www.aetnamedicare.com/formulary	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	305	0	1	04	01	H5521_305_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:50:31 PM Eastern Daylight Time	08/03/2022 03:25:42 PM Eastern Daylight Time	08/01/2022 12:15:04 AM Eastern Daylight Time			08/10/2022 03:37:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	305	0	2023	Panhandle/Northwest FL		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	306	0	1	04	01	H5521_306_0	2	1			2	0	0	07/12/2022	2023.01	07/12/2022 10:01:13 AM Eastern Daylight Time	07/12/2022 01:51:28 PM Eastern Daylight Time				07/20/2022 04:39:48 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	306	0	2023	Southwest FL		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	307	0	1	04	01	H5521_307_0	2	1						05/31/2022	2023.01	05/31/2022 08:12:11 PM Eastern Daylight Time	08/03/2022 03:20:37 PM Eastern Daylight Time	08/01/2022 12:15:30 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	307	0	2023	MI Upper Peninsula		2		2			2									www.aetnamdicare.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	308	0	1	04	01	H5521_308_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 07:58:13 PM Eastern Daylight Time	06/01/2022 02:04:54 PM Eastern Daylight Time				06/02/2022 12:10:14 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	308	0	2023	West FL		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	310	0	1	04	01	H5521_310_0	2	1						05/31/2022	2023.01	05/31/2022 11:15:14 PM Eastern Daylight Time	08/02/2022 05:58:13 PM Eastern Daylight Time	08/01/2022 12:15:58 AM Eastern Daylight Time			08/04/2022 05:15:42 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	2023	Metro Area: Brooklyn, NYC, Queens, Staten Island		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	311	0	1	04	01	H5521_311_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:51:32 AM Eastern Daylight Time	08/03/2022 03:21:31 PM Eastern Daylight Time	08/01/2022 12:16:24 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	311	0	2023	MI Upper Peninsula		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	312	0	1	04	01	H5521_312_0	2	1						05/31/2022	2023.01	05/31/2022 09:37:17 PM Eastern Daylight Time	08/02/2022 05:59:11 PM Eastern Daylight Time	08/01/2022 12:16:50 AM Eastern Daylight Time			08/04/2022 05:15:42 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	2023	Metro Area: Brooklyn, NYC, Queens		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	313	0	1	04	01	H5521_313_0	3	1						08/02/2022	2023.01	08/02/2022 03:18:26 PM Eastern Daylight Time	08/02/2022 06:00:12 PM Eastern Daylight Time	08/01/2022 12:17:16 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Credit Plan (PPO)	01	04		1			H5521	313	0	2023	Upstate NY Area: HV, Capital, CNY, Rochester, WNY		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	314	0	1	04	01	H5521_314_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:52:09 AM Eastern Daylight Time	08/03/2022 03:22:25 PM Eastern Daylight Time	08/01/2022 12:17:44 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Duly Prime (PPO)	01	04		1			H5521	314	0	2023	IL Chicago		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	318	0	1	04	01	H5521_318_0	2	1						08/02/2022	2023.01	08/02/2022 09:51:34 PM Eastern Daylight Time	08/02/2022 06:01:08 PM Eastern Daylight Time	08/01/2022 12:18:10 AM Eastern Daylight Time			08/04/2022 05:15:42 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	2023	Greater Rochester 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	319	0	1	04	01	H5521_319_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 12:22:14 PM Eastern Daylight Time	08/02/2022 08:39:28 PM Eastern Daylight Time	08/01/2022 12:18:36 AM Eastern Daylight Time			08/04/2022 09:15:43 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	2023	Greenville/Spartanburg SC 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		(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	1	1				0	0	05/31/2022	2023.01	05/31/2022 09:48:10 PM Eastern Daylight Time	06/01/2022 02:19:12 PM Eastern Daylight Time				06/02/2022 01:47:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	320	0	2023	Metro Area: LI, 5 Boroughs, Westchester/Rockland		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	321	0	1	04	01	H5521_321_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 12:21:45 PM Eastern Daylight Time	08/02/2022 08:40:27 PM Eastern Daylight Time	08/01/2022 12:19:02 AM Eastern Daylight Time			08/04/2022 09:15:43 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	2023	Nashville TN 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		(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			2	0	0	05/31/2022	2023.01	05/31/2022 07:51:35 PM Eastern Daylight Time	06/01/2022 12:52:32 PM Eastern Daylight Time				06/02/2022 12:30:34 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	322	0	2023	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	1	1				0	0	05/31/2022	2023.01	05/31/2022 09:49:36 PM Eastern Daylight Time	06/01/2022 02:20:11 PM Eastern Daylight Time				06/02/2022 01:47:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	323	0	2023	Upstate NY Area: HV, Capital, CNY, Rochester, WNY		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	324	0	1	04	01	H5521_324_0	2	1			2	0	0	05/31/2022	2023.01	05/31/2022 06:50:49 PM Eastern Daylight Time	06/29/2022 01:59:46 PM Eastern Daylight Time				06/30/2022 02:15:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	324	0	2023	Mississippi		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	326	0	1	04	01	H5521_326_0	2	1			1		0	08/03/2022	2023.01	08/03/2022 12:59:05 PM Eastern Daylight Time	08/03/2022 02:36:56 PM Eastern Daylight Time	08/01/2022 12:19:28 AM Eastern Daylight Time			08/04/2022 05:49:26 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	2023	New Orleans		2		2			2									www.aetnamedicare.com/findprovider	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	328	0	1	04	01	H5521_328_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 06:39:10 PM Eastern Daylight Time	08/03/2022 01:31:45 PM Eastern Daylight Time	08/01/2022 12:19:56 AM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	328	0	2023	Atlanta 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	329	0	1	04	01	H5521_329_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 11:03:26 AM Eastern Daylight Time	06/01/2022 02:21:10 PM Eastern Daylight Time				06/02/2022 01:04:31 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	329	0	2023	Arizona		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	330	0	1	04	01	H5521_330_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 11:34:54 PM Eastern Daylight Time	06/01/2022 02:14:23 PM Eastern Daylight Time				06/02/2022 12:35:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	330	0	2023	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			2		0	08/02/2022	2023.01	08/02/2022 01:49:35 PM Eastern Daylight Time	08/02/2022 02:20:43 PM Eastern Daylight Time	08/01/2022 12:20:22 AM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	331	0	2023	Counties COH, GIL, GRA, SC, YUM		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	332	0	1	04	01	H5521_332_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 01:59:33 PM Eastern Daylight Time	08/04/2022 01:39:06 PM Eastern Daylight Time	08/01/2022 12:20:50 AM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	332	0	2023	Fresno and Madera Counties		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	333	0	1	04	01	H5521_333_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 01:59:48 PM Eastern Daylight Time	08/04/2022 01:36:50 PM Eastern Daylight Time	08/01/2022 12:21:16 AM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	333	0	2023	Kern, Riverside and San Bernardino Counties		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	340	0	1	04	01	H5521_340_0	2	1						05/31/2022	2023.01	05/31/2022 09:50:53 PM Eastern Daylight Time	08/02/2022 06:04:07 PM Eastern Daylight Time	08/01/2022 12:21:42 AM Eastern Daylight Time			08/04/2022 05:15:42 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	2023	Northern Central Upstate NY		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	341	0	1	04	01	H5521_341_0	3	1						06/06/2022	2023.01	06/06/2022 12:07:53 PM Eastern Daylight Time	08/02/2022 06:05:02 PM Eastern Daylight Time	08/01/2022 12:22:08 AM Eastern Daylight Time			08/04/2022 05:15:42 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	2023	Nassau & Suffolk counties		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	344	0	1	04	01	H5521_344_0	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:30:44 AM Eastern Daylight Time	08/02/2022 01:25:54 PM Eastern Daylight Time	08/01/2022 12:22:34 AM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	344	0	2023	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		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	345	0	1	04	01	H5521_345_0	4	1			2		0	08/03/2022	2023.01	08/03/2022 10:31:50 AM Eastern Daylight Time	08/02/2022 01:26:51 PM Eastern Daylight Time	08/01/2022 12:23:02 AM Eastern Daylight Time			08/05/2022 11:35:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	345	0	2023	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		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	347	0	1	04	01	H5521_347_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 07:58:57 PM Eastern Daylight Time	06/01/2022 02:05:51 PM Eastern Daylight Time				06/02/2022 12:10:14 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	347	0	2023	North FL, South FL		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	348	0	1	04	01	H5521_348_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:21:15 PM Eastern Daylight Time	08/02/2022 08:41:29 PM Eastern Daylight Time	08/01/2022 12:23:28 AM Eastern Daylight Time			08/04/2022 06:02:41 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	348	0	2023	Eastern and Sandhills NC		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		(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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 12:54:52 PM Eastern Daylight Time	06/01/2022 01:43:23 PM Eastern Daylight Time				06/02/2022 12:24:27 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	349	0	2023	Maine & New Hampshire		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	350	0	1	04	01	H5521_350_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 12:55:33 PM Eastern Daylight Time	06/01/2022 01:44:40 PM Eastern Daylight Time				06/02/2022 12:24:27 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	350	0	2023	Connecticut		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	351	0	1	04	01	H5521_351_0	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 07:08:20 PM Eastern Daylight Time	06/01/2022 01:35:18 PM Eastern Daylight Time				06/02/2022 12:35:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	351	0	2023	Utah		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	352	0	1	04	01	H5521_352_0	2	1			2		1	08/01/2022	2023.01	08/01/2022 06:51:21 PM Eastern Daylight Time	08/02/2022 01:35:21 PM Eastern Daylight Time	08/01/2022 12:23:54 AM Eastern Daylight Time			08/04/2022 06:13:42 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	2023	Connecticut		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		(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			2	0	0	05/31/2022	2023.01	05/31/2022 07:09:13 PM Eastern Daylight Time	06/01/2022 01:36:16 PM Eastern Daylight Time				06/02/2022 12:35:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	353	0	2023	Nevada		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	354	0	1	04	01	H5521_354_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 03:05:06 PM Eastern Daylight Time	08/02/2022 08:42:32 PM Eastern Daylight Time	08/01/2022 12:24:20 AM Eastern Daylight Time			08/04/2022 06:02:41 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	354	0	2023	Charlotte Metro and Piedmont Area NC		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		(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	1	1			2	0	0	05/31/2022	2023.01	05/31/2022 02:55:28 PM Eastern Daylight Time	06/01/2022 02:46:04 PM Eastern Daylight Time				06/02/2022 12:24:27 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	355	0	2023	Tennessee		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	360	0	1	04	01	H5521_360_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:40:41 PM Eastern Daylight Time	08/03/2022 01:32:55 PM Eastern Daylight Time	08/01/2022 12:24:48 AM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Signature Plan (PPO)	01	04		1			H5521	360	0	2023	Select Counties in Georgia		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	363	0	1	04	01	H5521_363_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 01:49:52 PM Eastern Daylight Time	08/02/2022 02:21:44 PM Eastern Daylight Time	08/01/2022 12:25:14 AM Eastern Daylight Time			08/04/2022 05:35:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	363	0	2023	Maricopa, Pima and Pinal Counties		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(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	364	0	1	04	01	H5521_364_0	2	1			1		0	08/03/2022	2023.01	08/03/2022 01:02:14 PM Eastern Daylight Time	08/03/2022 02:37:56 PM Eastern Daylight Time	08/01/2022 12:25:40 AM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (PPO)	01	04		1			H5521	364	0	2023	Select Counties in Georgia		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	365	0	1	04	01	H5521_365_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:42:43 PM Eastern Daylight Time	08/03/2022 01:35:02 PM Eastern Daylight Time	08/01/2022 12:26:08 AM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Signature Plan (PPO)	01	04		1			H5521	365	0	2023	Select Counties in Louisiana		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	366	0	1	04	01	H5521_366_0	3	1			2		1	08/02/2022	2023.01	08/02/2022 06:43:30 PM Eastern Daylight Time	08/03/2022 01:36:09 PM Eastern Daylight Time	08/01/2022 12:26:34 AM Eastern Daylight Time			08/04/2022 05:49:26 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Signature Plan (PPO)	01	04		1			H5521	366	0	2023	Select Counties in Louisiana		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	369	0	1	04	01	H5521_369_0	3	1			2	0	0	05/31/2022	2023.01	05/31/2022 06:48:19 PM Eastern Daylight Time	06/01/2022 02:32:11 PM Eastern Daylight Time				06/02/2022 01:59:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plus Plan (PPO)	01	04		1			H5521	369	0	2023	California		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	370	0	1	04	01	H5521_370_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 02:00:16 PM Eastern Daylight Time	08/02/2022 03:53:06 PM Eastern Daylight Time	08/01/2022 12:27:00 AM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	370	0	2023	Amador, El Dorado and Solano Counties		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	371	0	1	04	01	H5521_371_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 02:00:27 PM Eastern Daylight Time	08/02/2022 03:54:04 PM Eastern Daylight Time	08/01/2022 12:27:26 AM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	371	0	2023	San Luis Obispo County		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	372	0	1	04	01	H5521_372_0	5	1			2		0	08/02/2022	2023.01	08/02/2022 02:00:39 PM Eastern Daylight Time	08/02/2022 03:55:18 PM Eastern Daylight Time	08/01/2022 12:27:52 AM Eastern Daylight Time			08/04/2022 05:26:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	372	0	2023	Santa Cruz County		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	373	0	1	04	01	H5521_373_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 12:19:13 PM Eastern Daylight Time	08/02/2022 08:44:40 PM Eastern Daylight Time	08/01/2022 12:28:20 AM Eastern Daylight Time			08/04/2022 06:02:41 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	373	0	2023	South Carolina GB		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	374	0	1	04	01	H5521_374_0	2	1			2		1	08/01/2022	2023.01	08/01/2022 06:51:46 PM Eastern Daylight Time	08/02/2022 01:36:16 PM Eastern Daylight Time	08/01/2022 12:28:46 AM Eastern Daylight Time			08/04/2022 06:13:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	374	0	2023	New Hampshire		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		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	375	0	1	04	01	H5521_375_0	2	1			2		0	08/01/2022	2023.01	08/01/2022 06:52:07 PM Eastern Daylight Time	08/02/2022 01:37:10 PM Eastern Daylight Time	08/01/2022 12:29:14 AM Eastern Daylight Time			08/04/2022 06:13:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	375	0	2023	Rhode Island		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		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	376	0	1	04	01	H5521_376_0	3	1			2		0	08/01/2022	2023.01	08/01/2022 06:40:58 PM Eastern Daylight Time	08/02/2022 01:38:06 PM Eastern Daylight Time	08/01/2022 12:29:40 AM Eastern Daylight Time			08/04/2022 06:13:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus (PPO)	01	04		1			H5521	376	0	2023	New Hampshire		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		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	377	0	1	04	01	H5521_377_0	4	1			2		0	08/10/2022	2023.01	08/10/2022 02:50:54 PM Eastern Daylight Time	08/03/2022 03:29:38 PM Eastern Daylight Time	08/01/2022 12:30:06 AM Eastern Daylight Time			08/10/2022 03:37:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	377	0	2023	West FL		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	378	0	1	04	01	H5521_378_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 08:31:23 PM Central Daylight Time	06/01/2022 12:59:23 PM Central Daylight Time				06/02/2022 03:10:36 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle 1 (PPO)	01	04		1			H5521	378	0	2023	Colorado		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	379	0	1	04	01	H5521_379_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 06:04:31 PM Eastern Daylight Time	08/02/2022 03:30:53 PM Eastern Daylight Time	08/01/2022 12:30:32 AM Eastern Daylight Time			08/04/2022 06:27:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	379	0	2023	Tri-Cities, Walla Walla and Yakima Counties		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	380	0	1	04	01	H5521_380_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 06:04:52 PM Eastern Daylight Time	08/02/2022 03:31:55 PM Eastern Daylight Time	08/01/2022 12:30:58 AM Eastern Daylight Time			08/04/2022 06:27:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Plan (PPO)	01	04		1			H5521	380	0	2023	Puget Sound Area and Spokane County		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	381	0	1	04	01	H5521_381_0	2	1						08/02/2022	2023.01	08/02/2022 09:53:48 PM Eastern Daylight Time	08/02/2022 06:06:05 PM Eastern Daylight Time	08/01/2022 12:31:24 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Discover Value Plan (PPO)	01	04		1			H5521	381	0	2023	Western NY		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	382	0	1	04	01	H5521_382_0	2	1						08/02/2022	2023.01	08/02/2022 02:16:14 PM Eastern Daylight Time	08/02/2022 06:07:03 PM Eastern Daylight Time	08/01/2022 12:31:48 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus Plan (PPO)	01	04		1			H5521	382	0	2023	Capital Region and Hudson Valley		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	383	0	1	04	01	H5521_383_0	2	1						05/31/2022	2023.01	05/31/2022 11:11:00 PM Eastern Daylight Time	08/02/2022 06:08:00 PM Eastern Daylight Time	08/01/2022 12:32:12 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Discover Value Plan (PPO)	01	04		1			H5521	383	0	2023	Capital Region and Hudson Valley		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	384	0	1	04	01	H5521_384_0	2	1						05/31/2022	2023.01	05/31/2022 09:57:15 PM Eastern Daylight Time	08/02/2022 06:08:57 PM Eastern Daylight Time	08/01/2022 12:32:38 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Discover Value Plan (PPO)	01	04		1			H5521	384	0	2023	Westchester and Rockland Counties		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	386	0	1	04	01	H5521_386_0	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:31:01 PM Eastern Daylight Time	08/03/2022 03:23:19 PM Eastern Daylight Time	08/01/2022 12:33:02 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	386	0	2023	WI Southeast		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	387	0	1	04	01	H5521_387_0	3	1			2		0	08/02/2022	2023.01	08/02/2022 10:52:52 AM Eastern Daylight Time	08/03/2022 03:24:13 PM Eastern Daylight Time	08/01/2022 12:33:26 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	387	0	2023	WI Central		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	388	0	1	04	01	H5521_388_0	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:32:19 PM Eastern Daylight Time	08/03/2022 03:25:06 PM Eastern Daylight Time	08/01/2022 12:33:52 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	388	0	2023	WI Central		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	389	0	1	04	01	H5521_389_0	3	1			2		0	07/22/2022	2023.01	07/22/2022 01:33:00 PM Eastern Daylight Time	08/03/2022 03:26:01 PM Eastern Daylight Time	08/01/2022 12:34:20 AM Eastern Daylight Time			08/04/2022 05:15:42 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	389	0	2023	WI Southern		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	390	0	1	04	01	H5521_390_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 11:55:25 AM Central Daylight Time	08/02/2022 04:12:04 PM Central Daylight Time	07/31/2022 11:34:46 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	390	0	2023	NNJ East Counties		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	391	0	1	04	01	H5521_391_0	2	1			2		0	08/02/2022	2023.01	08/02/2022 11:55:55 AM Central Daylight Time	08/02/2022 04:13:00 PM Central Daylight Time	07/31/2022 11:35:12 PM Central Daylight Time			08/04/2022 03:55:04 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	391	0	2023	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	(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	392	0	1	04	01	H5521_392_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:58:37 PM Eastern Daylight Time	08/02/2022 05:13:55 PM Eastern Daylight Time	08/01/2022 12:35:38 AM Eastern Daylight Time			08/10/2022 03:06:31 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Value (PPO)	01	04		1			H5521	392	0	2023	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	(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	393	0	1	04	01	H5521_393_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 03:07:54 PM Eastern Daylight Time	08/02/2022 03:32:55 PM Eastern Daylight Time	08/01/2022 12:36:06 AM Eastern Daylight Time			08/10/2022 03:45:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	393	0	2023	Mason County		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	801	0	1	04	01	H5521_801_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 08:58:34 AM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H5521	801	0	2023	National		1	8195940	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	802	0	1	04	01	H5521_802_0	1	1						05/31/2022	2023.01	05/31/2022 08:59:56 AM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	3632670	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	805	0	2	04	01	H5521_805_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 09:07:18 AM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	133190	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;14a;15;16b;	2		1									
H5521	806	0	2	04	01	H5521_806_0	1	1						05/31/2022	2023.01	05/31/2022 09:26:20 AM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	6360	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;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	05/31/2022	2023.01	05/31/2022 01:17:56 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $100 Buy-Down Plan (PPO)	01	04		1			H5521	809	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	810	0	1	04	01	H5521_810_0	1	1						05/31/2022	2023.01	05/31/2022 09:17:18 AM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $100 Buy-Down Plan w/Rx (PPO)	01	04		1			H5521	810	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	812	0	1	04	01	H5521_812_0	3	1						06/16/2022	2023.01	06/16/2022 11:11:15 AM Eastern Daylight Time					06/16/2022 11:11:47 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx $75 Buy-Down (PPO)	01	04		1			H5521	812	0	2023	National		1	179690	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;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	05/31/2022	2023.01	05/31/2022 01:19:29 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $100 Buy-Down Plan (PPO)	01	04		2	1		H5521	814	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	815	0	2	04	01	H5521_815_0	1	1						05/31/2022	2023.01	05/31/2022 01:20:00 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $100 Buy-Down Plan w/Rx (PPO)	01	04		2	1		H5521	815	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	816	0	2	04	01	H5521_816_0	1	1						05/31/2022	2023.01	05/31/2022 02:03:02 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $75 Buy-Down w/Rx (PPO)	01	04		2	1		H5521	816	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;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	05/27/2022	2023.01	05/27/2022 12:04:38 PM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;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	05/31/2022	2023.01	05/31/2022 01:26:34 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only Plan $75 Buy-Down (PPO)	01	04		2	1		H5521	818	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	819	0	1	04	01	H5521_819_0	1	1						05/27/2022	2023.01	05/27/2022 12:17:17 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx Metals (PPO)	01	04		1			H5521	819	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	820	0	1	04	01	H5521_820_0	1	1						05/27/2022	2023.01	05/27/2022 12:19:12 PM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;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	05/31/2022	2023.01	05/31/2022 01:28:40 PM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	822	0	1	04	01	H5521_822_0	1	1						05/31/2022	2023.01	05/31/2022 01:34:39 PM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;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	05/31/2022	2023.01	05/31/2022 01:38:49 PM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	824	0	2	04	01	H5521_824_0	1	1						05/31/2022	2023.01	05/31/2022 01:42:01 PM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;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	05/31/2022	2023.01	05/31/2022 01:43:12 PM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	826	0	2	04	01	H5521_826_0	1	1						05/31/2022	2023.01	05/31/2022 01:52:23 PM Eastern Daylight Time					06/02/2022 03:32:45 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	826	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;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	05/31/2022	2023.01	05/31/2022 01:54:54 PM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	828	0	2	04	01	H5521_828_0	1	1						05/31/2022	2023.01	05/31/2022 01:55:55 PM Eastern Daylight Time					06/02/2022 03:32:45 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	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	829	0	1	04	01	H5521_829_0	1	1						05/31/2022	2023.01	05/31/2022 02:00:08 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/RX Flex (PPO)	01	04		1			H5521	829	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	830	0	2	04	01	H5521_830_0	1	1						05/31/2022	2023.01	05/31/2022 02:07:25 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan Part B Only w/RX Flex (PPO)	01	04		2	1		H5521	830	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	831	0	1	04	01	H5521_831_0	1	1						05/31/2022	2023.01	05/31/2022 02:10:29 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan $75 Buy-Down w/RX Flex (PPO)	01	04		1			H5521	831	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	832	0	1	04	01	H5521_832_0	1	1						05/31/2022	2023.01	05/31/2022 02:12:50 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/RX CT (PPO)	01	04		1			H5521	832	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	833	0	1	04	01	H5521_833_0	1	1						05/31/2022	2023.01	05/31/2022 02:14:34 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/RX CP (PPO)	01	04		1			H5521	833	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	834	0	1	04	01	H5521_834_0	1	1						05/31/2022	2023.01	05/31/2022 02:15:50 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx Flex Sig+ (PPO)	01	04		1			H5521	834	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	835	0	2	04	01	H5521_835_0	1	1						05/31/2022	2023.01	05/31/2022 02:17:24 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only w/Rx Flex Sig+ (PPO)	01	04		2	1		H5521	835	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	836	0	1	04	01	H5521_836_0	1	1						05/31/2022	2023.01	05/31/2022 02:21:16 PM Eastern Daylight Time					06/02/2022 03:32:45 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan $75 Buy-Down w/Rx Flex Sig+ (PPO)	01	04		1			H5521	836	0	2023	National		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5522	001	0	1	04	01	H5522_001_0	2	1			1		1	05/31/2022	2023.01	05/31/2022 12:59:55 PM Eastern Daylight Time	08/03/2022 01:18:20 PM Eastern Daylight Time	08/01/2022 12:36:32 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier Plus (PPO)	01	04		1			H5522	001	0	2023	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	2	1			1		1	07/05/2022	2023.01	07/05/2022 10:21:39 AM Eastern Daylight Time	08/03/2022 01:19:30 PM Eastern Daylight Time	08/01/2022 12:37:00 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier Plus (PPO)	01	04		1			H5522	002	0	2023	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	08/02/2022	2023.01	08/02/2022 04:53:30 PM Eastern Daylight Time	08/03/2022 01:20:53 PM Eastern Daylight Time	08/01/2022 12:37:28 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (PPO)	01	04		1			H5522	004	0	2023	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	05/31/2022	2023.01	05/31/2022 01:04:48 PM Eastern Daylight Time	08/03/2022 01:22:25 PM Eastern Daylight Time	08/01/2022 12:37:54 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (PPO)	01	04		1			H5522	005	0	2023	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	2	1			2		1	05/31/2022	2023.01	05/31/2022 01:06:07 PM Eastern Daylight Time	08/03/2022 01:24:01 PM Eastern Daylight Time	08/01/2022 12:38:22 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver Plus (PPO)	01	04		1			H5522	013	0	2023	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	2	1			2		1	05/31/2022	2023.01	05/31/2022 01:07:18 PM Eastern Daylight Time	08/03/2022 01:25:07 PM Eastern Daylight Time	08/01/2022 12:38:48 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier Plus (PPO)	01	04		1			H5522	014	0	2023	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	05/31/2022	2023.01	05/31/2022 01:08:52 PM Eastern Daylight Time	08/03/2022 01:26:19 PM Eastern Daylight Time	08/01/2022 12:39:14 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Credit Value (PPO)	01	04		1			H5522	017	0	2023	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	020	0	1	04	01	H5522_020_0	3	1			2		0	08/10/2022	2023.01	08/10/2022 02:46:26 PM Eastern Daylight Time	08/03/2022 01:27:46 PM Eastern Daylight Time	08/01/2022 12:39:42 AM Eastern Daylight Time			08/10/2022 03:19:02 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Central Value (PPO)	01	04		1			H5522	020	0	2023	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	021	0	1	04	01	H5522_021_0	2	1			2		0	05/31/2022	2023.01	05/31/2022 01:10:59 PM Eastern Daylight Time	08/03/2022 01:28:59 PM Eastern Daylight Time	08/01/2022 12:40:08 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus (PPO)	01	04		1			H5522	021	0	2023	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	022	0	1	04	01	H5522_022_0	3	1			2		0	05/31/2022	2023.01	05/31/2022 01:12:17 PM Eastern Daylight Time	08/03/2022 01:30:12 PM Eastern Daylight Time	08/01/2022 12:40:34 AM Eastern Daylight Time			08/04/2022 05:04:50 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Silver Back (PPO)	01	04		1			H5522	022	0	2023	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	802	0	1	04	01	H5522_802_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 09:23:34 AM Eastern Daylight Time					06/02/2022 03:35:00 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H5522	802	0	2023	Pennsylvania		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5522	803	0	1	04	01	H5522_803_0	1	1						05/30/2022	2023.01	05/30/2022 10:40:18 AM Eastern Daylight Time					06/02/2022 03:35:00 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	01	04		1			H5522	803	0	2023	Pennsylvania		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5525	004	0	1	04	01	H5525_004_0	3	1			1		1	05/28/2022	2023.01	05/28/2022 10:57:07 AM Eastern Daylight Time	08/03/2022 03:51:47 PM Eastern Daylight Time	07/30/2022 08:24:30 AM Eastern Daylight Time			08/04/2022 11:31:07 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-004 (PPO)	01	04		1			H5525	004	0	2023	Peoria Illinois area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/30/2022	2023.01	05/30/2022 01:37:06 PM Eastern Daylight Time	08/03/2022 04:32:50 PM Eastern Daylight Time	07/30/2022 08:24:54 AM Eastern Daylight Time			08/04/2022 06:27:42 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	2023	Greater Philadelphia Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	006	0	1	04	01	H5525_006_0	4	1			1		1	05/30/2022	2023.01	05/30/2022 10:31:02 AM Eastern Daylight Time	08/03/2022 04:30:27 PM Eastern Daylight Time	07/30/2022 08:25:20 AM Eastern Daylight Time			08/04/2022 06:27:42 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	2023	South Central Pennsylvania area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/29/2022	2023.01	05/29/2022 03:36:11 PM Eastern Daylight Time	08/03/2022 04:29:17 PM Eastern Daylight Time	07/30/2022 08:25:44 AM Eastern Daylight Time			08/04/2022 12:11:10 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	2023	Select counties in Suburban Indiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/07/2022	2023.01	07/07/2022 10:11:33 AM Eastern Daylight Time	08/03/2022 03:52:19 PM Eastern Daylight Time	07/30/2022 08:26:10 AM Eastern Daylight Time			08/04/2022 02:45:38 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	2023	Select Louisiana Parishes		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/06/2022	2023.01	07/06/2022 01:26:13 PM Eastern Daylight Time	08/03/2022 04:36:34 PM Eastern Daylight Time	07/30/2022 08:26:34 AM Eastern Daylight Time			08/04/2022 06:27:42 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	2023	Western Pennsylvania Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	020	0	1	04	01	H5525_020_0	3	1			1		1	05/28/2022	2023.01	05/28/2022 06:16:34 PM Eastern Daylight Time	08/03/2022 03:47:41 PM Eastern Daylight Time	07/30/2022 08:27:00 AM Eastern Daylight Time			08/04/2022 12:45:32 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	2023	Mobile Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	022	0	1	04	01	H5525_022_0	3	1			1		1	07/14/2022	2023.01	07/14/2022 05:47:37 PM Eastern Daylight Time	08/03/2022 04:39:36 PM Eastern Daylight Time	07/30/2022 08:27:24 AM Eastern Daylight Time			08/04/2022 04:53:23 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	2023	Select counties in Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	024	0	1	04	01	H5525_024_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 01:38:03 PM Eastern Daylight Time	08/03/2022 05:25:00 PM Eastern Daylight Time	07/30/2022 08:27:50 AM Eastern Daylight Time			08/04/2022 03:56:59 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	2023	Select Counties in Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:40:25 PM Eastern Daylight Time	08/03/2022 04:05:50 PM Eastern Daylight Time	07/30/2022 08:28:14 AM Eastern Daylight Time			08/04/2022 03:24:52 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	2023	Select Counties in North Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/30/2022	2023.01	05/30/2022 09:42:24 AM Eastern Daylight Time	08/03/2022 03:47:19 PM Eastern Daylight Time	07/30/2022 08:28:40 AM Eastern Daylight Time			08/04/2022 12:37:53 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	2023	Select Counties in MT		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/16/2022	2023.01	08/16/2022 04:04:19 PM Eastern Daylight Time	08/03/2022 04:29:46 PM Eastern Daylight Time	07/30/2022 08:29:04 AM Eastern Daylight Time			08/16/2022 05:23:37 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	2023	Ohio & N KY		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1	1			2	0	0	05/30/2022	2023.01	05/30/2022 09:42:34 AM Eastern Daylight Time	06/01/2022 09:26:57 AM Eastern Daylight Time				06/02/2022 06:05:48 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5525	031	0	2023	Select Counties in ID, MT, WY		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:40:37 PM Eastern Daylight Time	08/03/2022 04:09:40 PM Eastern Daylight Time	07/30/2022 08:29:30 AM Eastern Daylight Time			08/04/2022 03:24:52 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	2023	Wilmington Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:41:21 PM Eastern Daylight Time	08/03/2022 04:11:41 PM Eastern Daylight Time	07/30/2022 08:29:54 AM Eastern Daylight Time			08/04/2022 03:24:52 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	2023	Select Counties in North Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:41:48 PM Eastern Daylight Time	08/03/2022 04:12:11 PM Eastern Daylight Time	07/30/2022 08:30:20 AM Eastern Daylight Time			08/04/2022 03:24:52 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	2023	Greater North Carolina Area		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	037	0	1	04	01	H5525_037_0	3	1			1		0	06/02/2022	2023.01	06/02/2022 01:22:07 PM Eastern Daylight Time	08/03/2022 03:59:46 PM Eastern Daylight Time	07/30/2022 08:30:46 AM Eastern Daylight Time			08/04/2022 02:45:38 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	2023	Select Louisiana Parishes		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/21/2022	2023.01	07/21/2022 01:15:31 PM Eastern Daylight Time	08/03/2022 04:42:11 PM Eastern Daylight Time	07/30/2022 08:31:10 AM Eastern Daylight Time			08/04/2022 12:35:10 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	2023	Select counties in Ohio		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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		1	08/01/2022	2023.01	08/01/2022 02:19:44 PM Eastern Daylight Time	08/03/2022 04:39:16 PM Eastern Daylight Time	07/30/2022 08:31:36 AM Eastern Daylight Time			08/04/2022 12:35:10 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	2023	Select counties in Ohio		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/30/2022	2023.01	05/30/2022 04:53:16 PM Eastern Daylight Time	08/03/2022 04:51:13 PM Eastern Daylight Time	07/30/2022 08:32:00 AM Eastern Daylight Time			08/04/2022 04:53:23 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	2023	Select Counties in Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:27:56 PM Eastern Daylight Time	08/03/2022 04:51:59 PM Eastern Daylight Time	07/30/2022 08:32:26 AM Eastern Daylight Time			08/04/2022 04:53:23 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	2023	Select Counties in Kentucky		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 02:30:21 PM Eastern Daylight Time	08/03/2022 04:43:08 PM Eastern Daylight Time	07/30/2022 08:32:52 AM Eastern Daylight Time			08/04/2022 12:35:10 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	2023	Select counties in Ohio		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 03:41:15 PM Eastern Daylight Time	08/03/2022 04:43:37 PM Eastern Daylight Time	07/30/2022 08:33:16 AM Eastern Daylight Time			08/04/2022 12:11:10 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	2023	Select counties in Indiana		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:42:35 PM Eastern Daylight Time	08/03/2022 04:14:57 PM Eastern Daylight Time	07/30/2022 08:33:42 AM Eastern Daylight Time			08/04/2022 03:24:52 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	2023	Eastern North Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2022	2023.01	08/01/2022 03:43:01 PM Eastern Daylight Time	08/03/2022 04:16:55 PM Eastern Daylight Time	07/30/2022 08:34:08 AM Eastern Daylight Time			08/04/2022 03:24:52 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	2023	Eastern and Northwest North Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:33:36 PM Eastern Daylight Time	08/03/2022 04:58:54 PM Eastern Daylight Time	07/30/2022 08:34:32 AM Eastern Daylight Time			08/04/2022 06:27:42 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	2023	Pennsylvania	Pennsylvania	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/02/2022	2023.01	08/02/2022 10:55:27 AM Eastern Daylight Time	08/03/2022 04:59:42 PM Eastern Daylight Time	07/30/2022 08:34:58 AM Eastern Daylight Time			08/04/2022 06:27:42 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	2023	Pennsylvania	Greater Philadelphia	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	052	0	1	04	01	H5525_052_0	2	1			1		1	05/29/2022	2023.01	05/29/2022 09:43:06 PM Eastern Daylight Time	08/03/2022 04:03:07 PM Eastern Daylight Time	07/30/2022 08:35:22 AM Eastern Daylight Time			08/04/2022 11:20:10 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-052 (PPO)	01	04		1			H5525	052	0	2023	Select Counties in WY		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	053	0	1	04	01	H5525_053_0	2	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 09:44:04 PM Eastern Daylight Time	08/03/2022 04:02:40 PM Eastern Daylight Time	07/30/2022 08:35:48 AM Eastern Daylight Time			08/04/2022 11:20:10 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5525-053 (PPO D-SNP)	01	04		1			H5525	053	0	2023	Select Counties in WY		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	054	0	1	04	01	H5525_054_0	2	1			1		1	05/30/2022	2023.01	05/30/2022 07:03:35 PM Eastern Daylight Time	08/03/2022 04:04:02 PM Eastern Daylight Time	07/30/2022 08:36:12 AM Eastern Daylight Time			08/04/2022 11:20:10 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-054 (PPO)	01	04		1			H5525	054	0	2023	Select Counties in ID,OR		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	055	0	1	04	01	H5525_055_0	5	1			1		1	08/16/2022	2023.01	08/16/2022 04:41:05 PM Eastern Daylight Time	08/03/2022 04:26:37 PM Eastern Daylight Time	07/30/2022 08:36:38 AM Eastern Daylight Time			08/16/2022 05:48:28 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-055 (PPO)	01	04		1			H5525	055	0	2023	San Francisco		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	056	0	1	04	01	H5525_056_0	4	1			1		1	07/22/2022	2023.01	07/22/2022 03:08:31 PM Eastern Daylight Time	08/03/2022 04:26:07 PM Eastern Daylight Time	07/30/2022 08:37:02 AM Eastern Daylight Time			08/04/2022 01:31:27 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-056 (PPO)	01	04		1			H5525	056	0	2023	Select Counties in California		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	057	0	1	04	01	H5525_057_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 02:00:53 PM Eastern Daylight Time	08/03/2022 04:28:06 PM Eastern Daylight Time	07/30/2022 08:37:28 AM Eastern Daylight Time			08/04/2022 01:27:17 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana USAA Honor with Rx (PPO)	01	04		1			H5525	057	0	2023	San Diego		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	058	0	1	04	01	H5525_058_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 05:58:50 PM Eastern Daylight Time	08/03/2022 05:01:23 PM Eastern Daylight Time	07/30/2022 08:37:54 AM Eastern Daylight Time			08/04/2022 03:15:10 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-058 (PPO)	01	04		1			H5525	058	0	2023	Pennsylvania		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	059	0	1	04	01	H5525_059_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 05:58:35 PM Eastern Daylight Time	08/03/2022 05:02:10 PM Eastern Daylight Time	07/30/2022 08:38:18 AM Eastern Daylight Time			08/04/2022 03:15:10 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana USAA Honor with Rx (PPO)	01	04		1			H5525	059	0	2023	Pennsylvania		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	060	0	1	04	01	H5525_060_0	4	1			1		1	08/02/2022	2023.01	08/02/2022 05:12:49 PM Eastern Daylight Time	08/03/2022 05:06:04 PM Eastern Daylight Time	07/30/2022 08:38:42 AM Eastern Daylight Time			08/04/2022 03:15:10 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-060 (PPO)	01	04		1			H5525	060	0	2023	Pennsylvania		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	061	0	1	04	01	H5525_061_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 04:41:14 PM Eastern Daylight Time	08/03/2022 03:56:57 PM Eastern Daylight Time	07/30/2022 08:39:08 AM Eastern Daylight Time			08/04/2022 03:02:51 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-061 (PPO)	01	04		1			H5525	061	0	2023	Select Counties in Rhode Island		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	062	0	1	04	01	H5525_062_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 07:49:40 PM Eastern Daylight Time	08/03/2022 03:58:19 PM Eastern Daylight Time	07/30/2022 08:39:32 AM Eastern Daylight Time			08/04/2022 03:02:51 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-062 (PPO)	01	04		1			H5525	062	0	2023	Select Counties in Rhode Island		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	063	0	1	04	01	H5525_063_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 07:51:04 PM Eastern Daylight Time	08/03/2022 03:59:00 PM Eastern Daylight Time	07/30/2022 08:39:58 AM Eastern Daylight Time			08/04/2022 03:02:51 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-063 (PPO)	01	04		1			H5525	063	0	2023	Select Counties in Rhode Island		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	064	0	1	04	01	H5525_064_0	3	1			2	0	0	08/03/2022	2023.01	08/03/2022 04:43:02 PM Eastern Daylight Time	07/18/2022 05:53:40 PM Eastern Daylight Time				08/05/2022 12:20:58 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5525	064	0	2023	Select Counties in Rhode Island		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5525	065	0	1	04	01	H5525_065_0	2	1			1	0	0	05/30/2022	2023.01	05/30/2022 03:43:24 PM Eastern Daylight Time	07/18/2022 05:23:26 PM Eastern Daylight Time				07/20/2022 02:28:11 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-065 (PPO)	01	04		1			H5525	065	0	2023	Select Counties in North Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5525	066	0	1	04	01	H5525_066_0	3	1			2	0	0	06/03/2022	2023.01	06/03/2022 11:07:00 AM Eastern Daylight Time	07/18/2022 05:40:38 PM Eastern Daylight Time				07/20/2022 01:51:02 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5525	066	0	2023	Select Counties in ND/SD		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5525	067	0	1	04	01	H5525_067_0	4	1			1		1	08/02/2022	2023.01	08/02/2022 12:49:44 PM Eastern Daylight Time	08/03/2022 04:22:47 PM Eastern Daylight Time	07/30/2022 08:40:22 AM Eastern Daylight Time			08/04/2022 11:14:32 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-067 (PPO)	01	04		1			H5525	067	0	2023	Select Counties in ND/SD		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	068	0	1	04	01	H5525_068_0	4	1			1		1	08/02/2022	2023.01	08/02/2022 01:00:19 PM Eastern Daylight Time	08/03/2022 04:25:40 PM Eastern Daylight Time	07/30/2022 08:40:48 AM Eastern Daylight Time			08/04/2022 11:31:07 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-068 (PPO)	01	04		1			H5525	068	0	2023	Select Counties in Illinois		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	069	0	1	04	01	H5525_069_0	3	1			1		1	06/02/2022	2023.01	06/02/2022 01:15:58 PM Eastern Daylight Time	08/03/2022 04:29:41 PM Eastern Daylight Time	07/30/2022 08:41:12 AM Eastern Daylight Time			08/04/2022 11:31:07 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-069 (PPO)	01	04		1			H5525	069	0	2023	Peoria Illinois area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1						05/27/2022	2023.01	05/27/2022 12:16:58 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	241770	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:17:18 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	2788	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:17:37 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:17:56 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:18:19 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	817	0	1	04	01	H5525_817_0	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:18:39 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	818	0	1	04	01	H5525_818_0	6	1						05/27/2022	2023.01	05/27/2022 12:19:00 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	819	0	1	04	01	H5525_819_0	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:19:19 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	820	0	1	04	01	H5525_820_0	6	1						05/27/2022	2023.01	05/27/2022 12:19:37 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	821	0	1	04	01	H5525_821_0	7	1				0	0	06/02/2022	2023.01	06/02/2022 10:13:37 AM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	822	0	1	04	01	H5525_822_0	4	1						05/31/2022	2023.01	05/31/2022 09:51:12 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	822	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	823	0	1	04	01	H5525_823_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 09:55:35 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	823	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	824	0	1	04	01	H5525_824_0	4	1						05/31/2022	2023.01	05/31/2022 09:58:08 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	824	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	825	0	1	04	01	H5525_825_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 10:00:06 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	825	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	826	0	1	04	01	H5525_826_0	4	1						05/31/2022	2023.01	05/31/2022 10:02:34 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	826	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	827	0	1	04	01	H5525_827_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 10:05:04 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	827	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	830	0	1	04	01	H5525_830_0	5	1						06/01/2022	2023.01	06/01/2022 10:19:16 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	830	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	831	0	1	04	01	H5525_831_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 10:10:58 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	831	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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									
H5526	004	0	1	04	01	H5526_004_0	8	1					1	07/18/2022	2023.01	07/18/2022 04:33:50 PM Eastern Daylight Time	08/04/2022 12:34:15 PM Eastern Daylight Time	08/04/2022 12:34:34 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Cross Blue Shield Forever Blue 751 (PPO)	01	04		1			H5526	004	0	2023	Western New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	016	0	1	04	01	H5526_016_0	7	1					1	07/18/2022	2023.01	07/18/2022 03:07:22 PM Eastern Daylight Time	08/04/2022 12:34:14 PM Eastern Daylight Time	08/04/2022 12:34:34 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Cross Blue Shield Forever Blue Value (PPO)	01	04		1			H5526	016	0	2023	Western New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	018	0	1	04	01	H5526_018_0	7	1					1	07/18/2022	2023.01	07/18/2022 03:07:09 PM Eastern Daylight Time	08/04/2022 12:34:14 PM Eastern Daylight Time	08/04/2022 12:34:33 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Shield Forever Blue 770 (PPO)	01	04		1			H5526	018	0	2023	Northeastern New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	020	0	1	04	01	H5526_020_0	7	1					1	07/18/2022	2023.01	07/18/2022 03:06:44 PM Eastern Daylight Time	08/04/2022 12:34:14 PM Eastern Daylight Time	08/04/2022 12:34:33 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Cross Blue Shield Freedom Nation (PPO)	01	04		1			H5526	020	0	2023	Western New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	021	0	1	04	01	H5526_021_0	7	1					1	07/18/2022	2023.01	07/18/2022 03:06:56 PM Eastern Daylight Time	08/04/2022 12:34:14 PM Eastern Daylight Time	08/04/2022 12:34:33 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Shield Freedom Nation (PPO)	01	04		1			H5526	021	0	2023	Northeastern New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	022	0	1	04	01	H5526_022_0	7	1						07/18/2022	2023.01	07/18/2022 03:06:23 PM Eastern Daylight Time	08/04/2022 12:34:14 PM Eastern Daylight Time	08/04/2022 12:34:33 PM Eastern Daylight Time			08/04/2022 12:47:25 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Shield Freedom Basic (PPO)	01	04		1			H5526	022	0	2023	Northeastern New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	023	0	1	04	01	H5526_023_0	6	1				0	0	07/18/2022	2023.01	07/18/2022 03:06:13 PM Eastern Daylight Time	07/19/2022 02:21:07 PM Eastern Daylight Time				07/19/2022 02:26:21 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Cross Blue Shield Freedom Valor (PPO)	01	04		1			H5526	023	0	2023	Western New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2215		(888)875-2215										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5526	024	0	1	04	01	H5526_024_0	6	1				0	0	07/18/2022	2023.01	07/18/2022 03:06:01 PM Eastern Daylight Time	07/19/2022 02:21:07 PM Eastern Daylight Time				07/19/2022 02:26:21 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Highmark Blue Shield Freedom Valor (PPO)	01	04		1			H5526	024	0	2023	Northeastern New York		2		2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.com	(800)329-2792		(800)329-2792		(888)875-2232		(888)875-2232										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5526	806	0	1	04	01	H5526_806_0	2	1				0	0	06/03/2022	2023.01	06/03/2022 01:51:40 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	PPO Group (MA Only) CY (PPO)	01	04		1			H5526	806	0	2023	Western and Northeastern New York		1	14672	2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.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;9a1;9b;10a;11a;11b;11c;14a;15;	2		1									
H5526	808	0	1	04	01	H5526_808_0	2	1						06/03/2022	2023.01	06/03/2022 01:53:46 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	PPO Group (MA-PD) CY (PPO)	01	04		1			H5526	808	0	2023	Western and Northeastern New York		1	100920	2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.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;9a1;9b;10a;11a;11b;11c;14a;15;	2		1									
H5526	813	0	1	04	01	H5526_813_0	2	1						06/03/2022	2023.01	06/03/2022 01:55:32 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	PPO Group  (MA-PD) ASO Calendar Year (PPO)	01	04		1			H5526	813	0	2023	Western and Northeastern New York		1	0	2			2									www.medicare.highmark.com	www.medicare.highmark.com	www.medicare.highmark.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;9a1;9b;10a;11a;11b;11c;14a;15;	2		1									
H5528	807	0	1	04	01	H5528_807_0	8	1						06/03/2022	2023.01	06/03/2022 08:20:54 AM Eastern Daylight Time					06/06/2022 05:17:28 PM Eastern Daylight Time	EMBLEMHEALTH PLAN, INC.	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Group Access Rx (PPO)	01	04		1			H5528	807	0	2023	New York		1	456	2			2									www.emblemhealth.com	www.emblemhealth.com		(866)557-7300		(866)557-7300		(800)447-2254		(800)447-2254		(866)557-7300		(866)557-7300		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-3;3-4;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;16b;	2		1									
H5528	815	0	1	04	01	H5528_815_0	8	1				0	0	06/01/2022	2023.01	06/01/2022 09:32:54 AM Eastern Daylight Time					06/06/2022 05:17:28 PM Eastern Daylight Time	EMBLEMHEALTH PLAN, INC.	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Group Access Rx Carveout (PPO)	01	04		1			H5528	815	0	2023	New York		1	200	2			2									www.emblemhealth.com	www.emblemhealth.com		(866)557-7300		(866)557-7300		(800)447-2254		(800)447-2254										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-3;3-4;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;16b;	2		1									
H5533	003	0	1	04	01	H5533_003_0	8	1					1	07/15/2022	2023.01	07/15/2022 06:32:46 AM Eastern Daylight Time	08/05/2022 12:22:57 AM Eastern Daylight Time	08/05/2022 12:23:38 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Western and Central Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	07/13/2022	2023.01	07/13/2022 07:41:46 PM Eastern Daylight Time	08/05/2022 12:22:59 AM Eastern Daylight Time	08/05/2022 12:23:39 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Western and Central Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	008	0	1	04	01	H5533_008_0	8	1					1	07/13/2022	2023.01	07/13/2022 07:48:17 PM Eastern Daylight Time	08/05/2022 12:23:00 AM Eastern Daylight Time	08/05/2022 12:23:40 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Western and Central Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	8	1					1	07/14/2022	2023.01	07/14/2022 01:47:49 PM Eastern Daylight Time	08/05/2022 12:23:02 AM Eastern Daylight Time	08/05/2022 12:23:42 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Central Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	8	1					1	08/04/2022	2023.01	08/04/2022 08:41:44 PM Eastern Daylight Time	08/05/2022 12:23:02 AM Eastern Daylight Time	08/05/2022 12:23:43 AM Eastern Daylight Time			08/05/2022 09:13:11 AM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO Premier Rx (PPO)	01	04		1			H5533	011	0	2023	Central Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	012	0	1	04	01	H5533_012_0	7	1				0	0	07/15/2022	2023.01	07/15/2022 06:33:26 AM Eastern Daylight Time	07/14/2022 02:43:56 PM Eastern Daylight Time				07/15/2022 04:29:55 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO Salute (PPO)	01	04		1			H5533	012	0	2023	Western, Central, and North Eastern Pennsylvania		2		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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5533	013	0	1	04	01	H5533_013_0	8	1					1	08/04/2022	2023.01	08/04/2022 09:15:08 PM Eastern Daylight Time	08/05/2022 12:23:04 AM Eastern Daylight Time	08/05/2022 12:23:47 AM Eastern Daylight Time			08/05/2022 09:13:11 AM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO Premier Rx (PPO)	01	04		1			H5533	013	0	2023	Western Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	01	7b;	
H5533	014	0	1	04	01	H5533_014_0	8	1					1	07/14/2022	2023.01	07/14/2022 01:47:24 PM Eastern Daylight Time	08/05/2022 12:23:05 AM Eastern Daylight Time	08/05/2022 12:23:56 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	014	0	2023	Western Pennsylvania		2		2			2									https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	https://www.upmchealthplan.com/medicare/learn/basics/learn-about-medicare-prescription-coverage.aspx	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	01	7b;	
H5533	801	0	1	04	01	H5533_801_0	4	1				0	0	05/27/2022	2023.01	05/27/2022 09:39:07 AM Eastern Daylight Time					06/05/2022 06:30:44 PM 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	2023	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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H5533	802	0	1	04	01	H5533_802_0	4	1						05/27/2022	2023.01	05/27/2022 09:41:54 AM Eastern Daylight Time					06/05/2022 06:30:44 PM 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	2023	Western Pennsylvania		1	6072	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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H5533	803	0	1	04	01	H5533_803_0	4	1						05/27/2022	2023.01	05/27/2022 09:44:02 AM Eastern Daylight Time					06/05/2022 06:30:44 PM 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	2023	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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H5549	003	0	1	01	01	H5549_003_0	7	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 04:49:21 PM Eastern Daylight Time	08/05/2022 01:47:40 PM Eastern Daylight Time	08/05/2022 01:47:40 PM Eastern Daylight Time			08/05/2022 02:11:58 PM Eastern Daylight Time	VNS CHOICE	VNS Health Medicare	www.vnsnychoice.org	VNS Health Total (HMO D-SNP)	01	01		1			H5549	003	0	2023	New York Metro Area		2		2			1	3		1					1	http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	www.vnsnychoice.org	(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5549	011	0	1	01	01	H5549_011_0	7	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 04:55:23 PM Eastern Daylight Time	08/05/2022 01:47:40 PM Eastern Daylight Time	08/05/2022 01:47:40 PM Eastern Daylight Time			08/05/2022 02:21:16 PM Eastern Daylight Time	VNS CHOICE	VNS Health Medicare	www.vnsnychoice.org	VNS Health EasyCare Plus (HMO D-SNP)	01	01		1			H5549	011	0	2023	New York Metro Area		2		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	6	1			1			08/03/2022	2023.01	08/03/2022 05:28:40 PM Eastern Daylight Time	08/05/2022 01:47:39 PM Eastern Daylight Time	08/05/2022 01:47:39 PM Eastern Daylight Time			08/05/2022 02:30:00 PM Eastern Daylight Time	VNS CHOICE	VNS Health Medicare	www.vnsnychoice.org	VNS Health EasyCare (HMO)	01	01		1			H5549	012	0	2023	New York Metro Area		2		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	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:16:23 PM Central Daylight Time	08/03/2022 11:59:14 AM Central Daylight Time	08/01/2022 04:34:02 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage STANDARD (HMO-POS)	01	02		1			H5576	017	1	2023	State of Louisiana	North & Central LA, EBR, JEFF, SHEL, TANG, TERR	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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:16:50 PM Central Daylight Time	08/03/2022 11:59:36 AM Central Daylight Time	08/01/2022 04:34:22 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage STANDARD (HMO-POS)	01	02		1			H5576	017	2	2023	State of Louisiana	North & 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	018	1	1	02	01	H5576_018_1	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:17:32 PM Central Daylight Time	08/03/2022 12:00:00 PM Central Daylight Time	08/01/2022 04:34:40 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage PREMIUM (HMO-POS)	01	02		1			H5576	018	1	2023	State of Louisiana	North & Central LA, EBR, JEFF, SHEL, TANG, TERR	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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:18:10 PM Central Daylight Time	08/03/2022 12:00:24 PM Central Daylight Time	08/01/2022 04:35:00 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage PREMIUM (HMO-POS)	01	02		1			H5576	018	2	2023	State of Louisiana	North & 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	019	0	1	02	01	H5576_019_0	9	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 12:18:43 PM Central Daylight Time	08/03/2022 12:00:50 PM Central Daylight Time	08/01/2022 04:35:20 PM Central Daylight Time			08/03/2022 08:59:57 PM 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	2023	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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	020	1	1	02	01	H5576_020_1	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:19:55 PM Central Daylight Time	08/03/2022 12:01:14 PM Central Daylight Time	08/01/2022 04:35:38 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage BASIC (HMO-POS)	01	02		1			H5576	020	1	2023	State of Louisiana	North & Central LA, EBR, JEFF, SHEL, TANG, TERR	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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:20:35 PM Central Daylight Time	08/03/2022 12:01:38 PM Central Daylight Time	08/01/2022 04:35:58 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage BASIC (HMO-POS)	01	02		1			H5576	020	2	2023	State of Louisiana	North & 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	022	0	1	02	01	H5576_022_0	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:21:21 PM Central Daylight Time	08/03/2022 12:02:02 PM Central Daylight Time	08/01/2022 04:36:16 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage 100 (HMO-POS)	01	02		1			H5576	022	0	2023	State of Louisiana		2		2			2									www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	023	0	1	02	01	H5576_023_0	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:22:11 PM Central Daylight Time	08/03/2022 12:02:26 PM Central Daylight Time	08/01/2022 04:36:34 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage Giveback (HMO-POS)	01	02		1			H5576	023	0	2023	State of Louisiana		2		2			2									www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	801	0	1	02	01	H5576_801_0	5	1						05/02/2022	2023.01	05/02/2022 09:52:44 AM Central Daylight Time					06/01/2022 03:31:58 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	2023	State of 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	802	0	1	02	01	H5576_802_0	5	1						05/02/2022	2023.01	05/02/2022 09:53:43 AM Central Daylight Time					06/01/2022 03:31:58 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	2023	State of 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	803	0	1	02	01	H5576_803_0	5	1				0	0	05/02/2022	2023.01	05/02/2022 09:54:38 AM Central Daylight Time					06/01/2022 03:31:58 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	2023	State of 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									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5577	002	0	1	01	01	H5577_002_0	7	1	1	1	2		0	08/04/2022	2023.01	08/04/2022 07:30:23 PM SA Western Standard Time	08/05/2022 12:07:02 PM SA Western Standard Time	08/05/2022 12:07:16 PM SA Western Standard Time			08/05/2022 12:20:50 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	2023	Puerto Rico		2		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	7	1			2		1	08/04/2022	2023.01	08/04/2022 07:33:45 PM SA Western Standard Time	08/05/2022 12:07:02 PM SA Western Standard Time	08/05/2022 12:07:16 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Efectivo (HMO)	01	01		1			H5577	005	0	2023	Puerto Rico		2		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	7	1			2		1	08/04/2022	2023.01	08/04/2022 07:34:36 PM SA Western Standard Time	08/05/2022 12:07:02 PM SA Western Standard Time	08/05/2022 12:07:17 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Essential (HMO-POS)	01	02		1			H5577	008	0	2023	Puerto Rico		2		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	5	1			2		1	08/04/2022	2023.01	08/04/2022 07:35:33 PM SA Western Standard Time	08/05/2022 12:07:02 PM SA Western Standard Time	08/05/2022 12:07:17 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Freedom (HMO)	01	01		1			H5577	014	0	2023	Puerto Rico		2		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	6	1			2	0	0	07/24/2022	2023.01	07/24/2022 02:52:22 PM SA Western Standard Time	07/13/2022 03:01:15 PM SA Western Standard Time				07/25/2022 09:47:58 AM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Patriot (HMO)	01	01		1			H5577	016	0	2023	Puerto Rico		2		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	7	1	1	1	2		0	08/04/2022	2023.01	08/04/2022 07:37:07 PM SA Western Standard Time	08/05/2022 12:07:03 PM SA Western Standard Time	08/05/2022 12:07:17 PM SA Western Standard Time			08/05/2022 12:20:50 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	2023	Puerto Rico		2		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	7	1	1	1	2		0	08/04/2022	2023.01	08/04/2022 07:41:07 PM SA Western Standard Time	08/05/2022 12:07:03 PM SA Western Standard Time	08/05/2022 12:07:18 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino MasCa$h (HMO D-SNP)	01	01		1			H5577	029	0	2023	Puerto Rico		2		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	7	1			2		1	08/04/2022	2023.01	08/04/2022 07:43:25 PM SA Western Standard Time	08/05/2022 12:07:03 PM SA Western Standard Time	08/05/2022 12:07:18 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Activo (HMO)	01	01		1			H5577	031	0	2023	Puerto Rico		2		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	037	0	1	01	01	H5577_037_0	8	1	1	1	1		0	08/04/2022	2023.01	08/04/2022 08:11:13 PM SA Western Standard Time	08/05/2022 12:07:04 PM SA Western Standard Time	08/05/2022 12:07:18 PM SA Western Standard Time			08/05/2022 12:20:50 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	2023	Puerto Rico		2		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	8	1		1	2		1	08/04/2022	2023.01	08/04/2022 07:48:45 PM SA Western Standard Time	08/05/2022 12:07:04 PM SA Western Standard Time	08/05/2022 12:07:19 PM SA Western Standard Time			08/05/2022 12:20:50 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	2023	Puerto Rico		2		2			1	4			00000000000000000010000					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	7	1			2		1	08/04/2022	2023.01	08/04/2022 07:50:31 PM SA Western Standard Time	08/05/2022 12:07:04 PM SA Western Standard Time	08/05/2022 12:07:19 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare SuperRx (HMO)	01	01		1			H5577	039	0	2023	Puerto Rico		2		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	7	1	1	1	2		0	08/04/2022	2023.01	08/04/2022 07:51:49 PM SA Western Standard Time	08/05/2022 12:07:04 PM SA Western Standard Time	08/05/2022 12:07:19 PM SA Western Standard Time			08/05/2022 12:20:50 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	2023	Puerto Rico West 39		2		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	7	1			2		1	08/04/2022	2023.01	08/04/2022 07:53:16 PM SA Western Standard Time	08/05/2022 12:07:05 PM SA Western Standard Time	08/05/2022 12:07:20 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Firme (HMO)	01	01		1			H5577	042	0	2023	Puerto Rico West 39		2		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	7	1			2		1	08/04/2022	2023.01	08/04/2022 07:54:12 PM SA Western Standard Time	08/05/2022 12:07:05 PM SA Western Standard Time	08/05/2022 12:07:20 PM SA Western Standard Time			08/05/2022 12:20:50 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	2023	Puerto Rico		2		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	7	1			2		1	08/04/2022	2023.01	08/04/2022 07:56:20 PM SA Western Standard Time	08/05/2022 12:07:05 PM SA Western Standard Time	08/05/2022 12:07:20 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Hero (HMO)	01	01		1			H5577	044	0	2023	Puerto Rico		2		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	8	1		1	2		1	08/04/2022	2023.01	08/04/2022 07:58:59 PM SA Western Standard Time	08/05/2022 12:07:05 PM SA Western Standard Time	08/05/2022 12:07:21 PM SA Western Standard Time			08/05/2022 12:20:50 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	2023	Puerto Rico West 39		2		2			1	4			00000000000000000010000					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	046	0	1	01	01	H5577_046_0	7	1	1	1	1		0	08/04/2022	2023.01	08/04/2022 08:09:47 PM SA Western Standard Time	08/05/2022 12:07:06 PM SA Western Standard Time	08/05/2022 12:07:21 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Total (HMO D-SNP)	01	01		1			H5577	046	0	2023	Puerto Rico		2		2		1	1	3		1					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	047	0	1	01	01	H5577_047_0	8	1			2		1	08/04/2022	2023.01	08/04/2022 08:01:35 PM SA Western Standard Time	08/05/2022 12:07:06 PM SA Western Standard Time	08/05/2022 12:07:21 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare En Tu Casa (HMO)	01	01		1			H5577	047	0	2023	Puerto Rico		2		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	049	0	1	01	01	H5577_049_0	7	1			2		1	08/04/2022	2023.01	08/04/2022 08:02:50 PM SA Western Standard Time	08/05/2022 12:07:06 PM SA Western Standard Time	08/05/2022 12:07:21 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Electrico (HMO)	01	01		1			H5577	049	0	2023	Puerto Rico		2		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	050	0	1	02	01	H5577_050_0	6	1			2		1	08/04/2022	2023.01	08/04/2022 08:04:15 PM SA Western Standard Time	08/05/2022 12:07:07 PM SA Western Standard Time	08/05/2022 12:07:22 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Acceso (HMO-POS)	01	02		1			H5577	050	0	2023	Puerto Rico		2		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	051	0	1	01	01	H5577_051_0	8	1			2		1	08/04/2022	2023.01	08/04/2022 08:05:38 PM SA Western Standard Time	08/05/2022 12:07:07 PM SA Western Standard Time	08/05/2022 12:07:22 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Metro (HMO)	01	01		1			H5577	051	0	2023	Puerto Rico Metro 8		2		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	052	0	1	01	01	H5577_052_0	7	1			2		1	08/04/2022	2023.01	08/04/2022 08:06:57 PM SA Western Standard Time	08/05/2022 12:07:07 PM SA Western Standard Time	08/05/2022 12:07:22 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare InteliCare (HMO)	01	01		1			H5577	052	0	2023	Puerto Rico		2		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	053	0	1	01	01	H5577_053_0	7	1			2		1	08/04/2022	2023.01	08/04/2022 08:08:42 PM SA Western Standard Time	08/05/2022 12:07:08 PM SA Western Standard Time	08/05/2022 12:07:23 PM SA Western Standard Time			08/05/2022 12:20:50 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Exacto (HMO)	01	01		1			H5577	053	0	2023	Puerto Rico		2		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	801	0	1	01	01	H5577_801_0	4	1				0	0	06/05/2022	2023.01	06/05/2022 04:11:47 PM SA Western Standard Time					06/06/2022 09:52:24 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA Group (HMO)	01	01		1			H5577	801	0	2023	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	4	1						06/05/2022	2023.01	06/05/2022 04:22:30 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	Puerto Rico		1	86000	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	4	1						06/05/2022	2023.01	06/05/2022 04:49:23 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	Puerto Rico		1	128000	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						06/05/2022	2023.01	06/05/2022 04:49:08 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	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	820	0	1	01	01	H5577_820_0	3	1						06/05/2022	2023.01	06/05/2022 04:48:58 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	Puerto Rico		1	52000	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						06/05/2022	2023.01	06/05/2022 04:48:22 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	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	822	0	1	01	01	H5577_822_0	3	1						06/05/2022	2023.01	06/05/2022 04:47:54 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	Puerto Rico		1	31000	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						06/05/2022	2023.01	06/05/2022 04:47:15 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	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						06/05/2022	2023.01	06/05/2022 04:46:54 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	Puerto Rico		1	44000	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						06/05/2022	2023.01	06/05/2022 04:46:17 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	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						06/05/2022	2023.01	06/05/2022 04:45:46 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	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						06/05/2022	2023.01	06/05/2022 04:45:20 PM SA Western Standard Time					06/06/2022 09:52:24 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	2023	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	4	1	2	1	2		0	08/04/2022	2023.01	08/04/2022 11:01:29 PM Eastern Daylight Time	08/04/2022 10:09:03 PM Eastern Daylight Time	08/02/2022 12:33:43 PM Eastern Daylight Time			08/05/2022 09:52:39 AM Eastern Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAz.org	Mercy Care Advantage (HMO D-SNP)	01	01		1			H5580	001	0	2023	Maricopa, Pinal, and Gila Counties		2		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	2		0	08/04/2022	2023.01	08/04/2022 11:02:56 PM Eastern Daylight Time	08/04/2022 10:10:43 PM Eastern Daylight Time	08/02/2022 12:39:35 PM Eastern Daylight Time			08/05/2022 09:52:39 AM Eastern Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAz.org	Mercy Care Advantage (HMO D-SNP)	01	01		1			H5580	004	0	2023	Maricopa, Gila, Pinal, and Pima Counties		2		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	2		0	08/04/2022	2023.01	08/04/2022 11:03:51 PM Eastern Daylight Time	08/04/2022 10:11:58 PM Eastern Daylight Time	08/02/2022 12:50:10 PM Eastern Daylight Time			08/05/2022 09:52:39 AM Eastern Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAz.org	Mercy Care Advantage (HMO D-SNP)	01	01		1			H5580	005	0	2023	Arizona Statewide		2		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	11	1	2	1	1		0	08/05/2022	2023.01	08/05/2022 12:26:45 PM US Mountain Standard Time	08/05/2022 12:22:15 PM US Mountain Standard Time	08/05/2022 12:22:31 PM US Mountain Standard Time			08/05/2022 12:32:45 PM US Mountain Standard Time	HEALTH CHOICE ARIZONA, INC.	Health Choice Arizona	https://www.healthchoicepathway.com	BCBSAZ Health Choice Pathway (HMO D-SNP)	01	01		1			H5587	002	0	2023	Arizona: APA, CCN, GIL, MAR, MOH, NAV, PIN, YAV		2		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						08/03/2022	2023.01	08/03/2022 02:35:29 PM Eastern Daylight Time	08/03/2022 04:35:50 PM Pacific Daylight Time	07/30/2022 06:46:39 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific 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	2023	Select counties in AZ		2		2			2									www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	007	0	1	01	01	H5590_007_0	4	1						05/26/2022	2023.01	05/26/2022 10:25:02 AM Eastern Daylight Time	08/03/2022 04:37:02 PM Pacific Daylight Time	07/30/2022 06:47:10 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	Bridgeway Health Solutions of Arizona, Inc.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Assist (HMO)	01	01		1			H5590	007	0	2023	Select counties in AZ		2		2			2									www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	008	0	1	01	01	H5590_008_0	6	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 02:01:22 PM Eastern Daylight Time	08/03/2022 04:38:14 PM Pacific Daylight Time	07/30/2022 06:47:43 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific 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	2023	Select counties in AZ		2		2			1	3		1					1	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	009	0	1	01	01	H5590_009_0	7	1	2	1	1		0	07/19/2022	2023.01	07/19/2022 11:17:42 AM Eastern Daylight Time	08/03/2022 04:39:29 PM Pacific Daylight Time	07/30/2022 06:48:15 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific 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	2023	Select counties in AZ		2		2			1	3		1					1	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(800)977-7522		(800)977-7522		(844)917-0175		(844)917-0175		(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	07/18/2022	2023.01	07/18/2022 08:20:27 AM Eastern Daylight Time	06/03/2022 12:38:43 PM Eastern Daylight Time				07/18/2022 09:30:27 AM 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	2023	All Maine & NH Counties		2		2			2									MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5591	005	0	1	02	01	H5591_005_0	4	1					1	08/03/2022	2023.01	08/03/2022 04:28:44 PM Eastern Daylight Time	08/05/2022 09:13:24 AM Eastern Daylight Time	08/05/2022 09:13:36 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	Southern NH Counties		2		2			2									MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	006	1	1	02	01	H5591_006_1	4	1					1	08/03/2022	2023.01	08/03/2022 03:12:58 PM Eastern Daylight Time	08/05/2022 09:13:48 AM Eastern Daylight Time	08/05/2022 09:14:01 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	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)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	006	2	1	02	01	H5591_006_2	4	1					1	08/03/2022	2023.01	08/03/2022 04:14:18 PM Eastern Daylight Time	08/05/2022 09:14:15 AM Eastern Daylight Time	08/05/2022 09:14:27 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	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)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	006	4	1	02	01	H5591_006_4	4	1					1	08/04/2022	2023.01	08/04/2022 11:07:46 AM Eastern Daylight Time	08/05/2022 09:14:40 AM Eastern Daylight Time	08/05/2022 09:14:53 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	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)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	006	5	1	02	01	H5591_006_5	5	1					1	08/04/2022	2023.01	08/04/2022 11:08:49 AM Eastern Daylight Time	08/05/2022 12:37:41 PM Eastern Daylight Time	08/05/2022 12:37:28 PM Eastern Daylight Time			08/05/2022 12:51:29 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	2023	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)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	007	0	1	01	01	H5591_007_0	4	1		1			1	08/03/2022	2023.01	08/03/2022 04:49:49 PM Eastern Daylight Time	08/05/2022 09:10:04 AM Eastern Daylight Time	08/05/2022 09:10:16 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	Cumberland County		2		2			1	4			00000010000000000000000					MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	009	0	1	01	01	H5591_009_0	5	1					1	08/03/2022	2023.01	08/03/2022 04:58:05 PM Eastern Daylight Time	08/05/2022 09:10:29 AM Eastern Daylight Time	08/05/2022 09:10:41 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	Northern, Central, and Midcoast Maine		2		2			2									MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	013	0	1	01	01	H5591_013_0	5	1					1	08/03/2022	2023.01	08/03/2022 05:02:06 PM Eastern Daylight Time	08/05/2022 09:10:54 AM Eastern Daylight Time	08/05/2022 09:11:06 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	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)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	015	1	1	02	01	H5591_015_1	4	1					1	08/03/2022	2023.01	08/03/2022 04:35:39 PM Eastern Daylight Time	08/05/2022 09:11:19 AM Eastern Daylight Time	08/05/2022 09:11:30 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	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)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	015	2	1	02	01	H5591_015_2	4	1					1	08/04/2022	2023.01	08/04/2022 08:13:09 AM Eastern Daylight Time	08/05/2022 09:11:43 AM Eastern Daylight Time	08/05/2022 09:11:55 AM Eastern Daylight Time			08/05/2022 11:50:51 AM 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	2023	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)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	801	0	1	02	01	H5591_801_0	4	1						07/18/2022	2023.01	07/18/2022 08:34:56 AM Eastern Daylight Time					07/18/2022 09:30:27 AM 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	2023	National		1	0	2			2									MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	802	0	1	02	01	H5591_802_0	4	1						07/18/2022	2023.01	07/18/2022 08:37:00 AM Eastern Daylight Time					07/18/2022 09:30:27 AM 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	2023	National		1	0	2			2									MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(866)544-7504		(866)544-7504		(888)408-8289		(888)408-8289		(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	05/31/2022	2023.01	05/31/2022 12:58:11 PM Central Daylight Time	08/02/2022 01:00:55 PM Central Daylight Time	07/31/2022 11:41:02 PM Central Daylight Time			08/05/2022 11:14:22 AM 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	2023	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	05/30/2022	2023.01	05/30/2022 06:18:52 PM Eastern Daylight Time					06/02/2022 03:36:33 PM Eastern Daylight Time	AETNA HEALTH OF IOWA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5593	801	0	2023	Iowa		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H5593	802	0	1	01	01	H5593_802_0	1	1						05/31/2022	2023.01	05/31/2022 08:50:34 AM Eastern Daylight Time					06/02/2022 03:36:33 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	2023	Iowa		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H5594	001	0	1	01	01	H5594_001_0	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:38:22 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	001	0	2023	Select Counties in Florida		2		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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:38:50 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO)	01	01		1			H5594	002	0	2023	Select Counties in Florida		2		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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:01:32 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:02:39 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		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	5	1			2		0	05/24/2022	2023.01	05/24/2022 09:15:28 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Plan (HMO)	01	01		1			H5594	019	0	2023	Select Counties in Florida		2		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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:40:29 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	022	0	2023	Select Counties in Florida		2		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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:40:52 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	026	0	2023	Select Counties in Florida		2		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	6	1		1	2		1	05/14/2022	2023.01	05/14/2022 09:41:19 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		2			1	4			00000000000000000010000					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	5	1		1	2		0	05/14/2022	2023.01	05/14/2022 09:41:54 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	Select Counties in Florida		2		2			1	4			00000000000100000000000					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	10	1		1	2		0	05/24/2022	2023.01	05/24/2022 11:04:39 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Savings (HMO C-SNP)	01	01		1			H5594	030	0	2023	Select Counties in Florida		2		2			1	4			00000000000000000010000					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	5	1		1	2		0	05/24/2022	2023.01	05/24/2022 11:04:30 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Savings COPD (HMO C-SNP)	01	01		1			H5594	031	0	2023	Select Counties in Florida		2		2			1	4			00000000000100000000000					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	5	1			2		0	05/14/2022	2023.01	05/14/2022 09:43:01 AM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time	08/04/2022 11:08:00 PM Eastern Daylight Time			08/04/2022 07:35:20 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Plus Plan (HMO)	01	01		1			H5594	032	0	2023	Select Counties in Florida		2		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	5	1		1	2		0	05/14/2022	2023.01	05/14/2022 09:43:20 AM Eastern Daylight Time	08/04/2022 11:09:00 PM Eastern Daylight Time	08/04/2022 11:09:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	select counties in FL		2		2			1	4			00000000000000000010000					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	5	1		1	2		0	05/14/2022	2023.01	05/14/2022 09:44:02 AM Eastern Daylight Time	08/04/2022 11:09:00 PM Eastern Daylight Time	08/04/2022 11:09:00 PM Eastern Daylight Time			08/04/2022 07:35:20 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	2023	select counties in FL		2		2			1	4			00000000000100000000000					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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:18:31 PM Eastern Daylight Time	08/03/2022 08:00:26 PM Eastern Daylight Time	07/30/2022 09:48:48 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		2			1	3		1					1	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	002	0	1	02	01	H5599_002_0	4	1						05/27/2022	2023.01	05/27/2022 03:58:04 PM Eastern Daylight Time	08/03/2022 08:01:36 PM Eastern Daylight Time	07/30/2022 09:49:19 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		2			2									www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	003	0	1	01	01	H5599_003_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:21:38 PM Eastern Daylight Time	08/03/2022 08:02:48 PM Eastern Daylight Time	07/30/2022 09:49:51 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		2			1	3		1					1	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	004	0	1	01	01	H5599_004_0	4	1						08/03/2022	2023.01	08/03/2022 03:07:04 PM Eastern Daylight Time	08/03/2022 08:03:57 PM Eastern Daylight Time	07/30/2022 09:50:23 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		2			2									www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	008	0	1	01	01	H5599_008_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:25:37 PM Eastern Daylight Time	08/03/2022 08:05:06 PM Eastern Daylight Time	07/30/2022 09:50:55 AM Eastern Daylight Time			08/04/2022 05:30:37 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	2023	Select counties in NY		2		2			1	3		1					1	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(800)247-1447		(800)247-1447		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	801	0	1	02	01	H5599_801_0	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:18:05 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:18:10 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:18:15 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	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	8	1	2	1			0	08/05/2022	2023.01	08/05/2022 11:15:26 AM Central Daylight Time	08/03/2022 01:06:40 PM Central Daylight Time	08/01/2022 03:29:47 PM Central Daylight Time			08/05/2022 11:16:13 AM Central Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Elevate Medicare Advantage	www.denverhealthmedicalplan.org	Elevate Medicare Choice (HMO D-SNP)	01	01		1			H5608	001	0	2023	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	8	1					1	08/05/2022	2023.01	08/05/2022 11:15:05 AM Central Daylight Time	08/03/2022 01:09:05 PM Central Daylight Time	08/01/2022 03:31:05 PM Central Daylight Time			08/05/2022 11:16:13 AM Central Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Elevate Medicare Advantage	www.denverhealthmedicalplan.org	Elevate Medicare Select (HMO)	01	01		1			H5608	002	0	2023	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						06/01/2022	2023.01	06/01/2022 01:04:26 PM Eastern Daylight Time		05/31/2022 05:41:36 PM Eastern Daylight Time			06/01/2022 01:06:52 PM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.careresources.org	Care Resources (PACE)	08	20		1			H5610	001	0	2023	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						06/01/2022	2023.01	06/01/2022 01:04:54 PM Eastern Daylight Time		05/31/2022 05:41:54 PM Eastern Daylight Time			06/01/2022 01:06:52 PM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.careresources.org	Care Resources (PACE)	08	20		1			H5610	003	0	2023	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)-																
H5619	001	0	1	01	01	H5619_001_0	2	1			1		1	08/01/2022	2023.01	08/01/2022 05:41:26 PM Eastern Daylight Time	08/03/2022 03:38:21 PM Eastern Daylight Time	07/30/2022 08:41:38 AM Eastern Daylight Time			08/04/2022 03:02:51 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	2023	Southern Maine		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 03:37:59 PM Eastern Daylight Time	08/03/2022 03:35:45 PM Eastern Daylight Time	07/30/2022 08:42:04 AM Eastern Daylight Time			08/04/2022 05:47:42 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	2023	Maine		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:21:16 AM Eastern Daylight Time	08/03/2022 04:06:51 PM Eastern Daylight Time	07/30/2022 08:42:28 AM Eastern Daylight Time			08/04/2022 01:37:23 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	2023	Fresno County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:19:04 PM Eastern Daylight Time	08/03/2022 04:10:20 PM Eastern Daylight Time	07/30/2022 08:42:54 AM Eastern Daylight Time			08/04/2022 01:37:23 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	2023	Madera County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/01/2022	2023.01	08/01/2022 11:21:56 AM Eastern Daylight Time	08/03/2022 04:07:21 PM Eastern Daylight Time	07/30/2022 08:43:20 AM Eastern Daylight Time			08/04/2022 01:37:23 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	2023	Tulare and Kings counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	016	0	1	01	01	H5619_016_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:22:10 AM Eastern Daylight Time	08/03/2022 04:08:20 PM Eastern Daylight Time	07/30/2022 08:43:44 AM Eastern Daylight Time			08/04/2022 01:37:23 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	2023	San Diego County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 11:22:29 AM Eastern Daylight Time	08/03/2022 04:09:49 PM Eastern Daylight Time	07/30/2022 08:44:10 AM Eastern Daylight Time			08/04/2022 01:37:23 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	2023	Los Angeles and Orange counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 10:30:41 AM Eastern Daylight Time	08/03/2022 04:08:50 PM Eastern Daylight Time	07/30/2022 08:44:34 AM Eastern Daylight Time			08/04/2022 01:37:23 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	2023	San Joaquin County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 10:31:00 AM Eastern Daylight Time	08/03/2022 04:09:19 PM Eastern Daylight Time	07/30/2022 08:44:58 AM Eastern Daylight Time			08/04/2022 01:37:23 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	2023	Contra Costa County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:22:47 AM Eastern Daylight Time	08/03/2022 04:07:50 PM Eastern Daylight Time	07/30/2022 08:45:24 AM Eastern Daylight Time			08/04/2022 01:37:23 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	2023	Stanislaus County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 02:41:03 PM Eastern Daylight Time	08/03/2022 04:13:47 PM Eastern Daylight Time	07/30/2022 08:45:50 AM Eastern Daylight Time			08/04/2022 01:37:23 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	2023	Select Counties in California		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/04/2022	2023.01	08/04/2022 04:22:34 PM Eastern Daylight Time	08/03/2022 04:10:49 PM Eastern Daylight Time	07/30/2022 08:46:14 AM Eastern Daylight Time			08/04/2022 04:41:23 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	2023	Riverside and San Bernardino counties	Riverside and San Bernardino counties	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/04/2022	2023.01	08/04/2022 04:22:45 PM Eastern Daylight Time	08/03/2022 04:11:18 PM Eastern Daylight Time	07/30/2022 08:46:40 AM Eastern Daylight Time			08/04/2022 04:41:23 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	2023	Riverside and San Bernardino counties	Riverside and San Bernardino counties	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	06/02/2022	2023.01	06/02/2022 05:52:04 PM Eastern Daylight Time	08/03/2022 04:01:58 PM Eastern Daylight Time	07/30/2022 08:47:04 AM Eastern Daylight Time			08/04/2022 03:15:59 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	2023	Charlottesville		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1		1	1		1	08/02/2022	2023.01	08/02/2022 12:56:36 PM Eastern Daylight Time	08/03/2022 04:02:28 PM Eastern Daylight Time	07/30/2022 08:47:30 AM Eastern Daylight Time			08/04/2022 03:15:59 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	046	0	2023	Richmond-Tidewater Area		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:44:15 PM Eastern Daylight Time	08/03/2022 04:02:57 PM Eastern Daylight Time	07/30/2022 08:47:56 AM Eastern Daylight Time			08/04/2022 03:15:59 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	2023	Northern Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H5619_049_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:37:26 PM Eastern Daylight Time	08/03/2022 04:21:37 PM Eastern Daylight Time	07/30/2022 08:48:20 AM Eastern Daylight Time			08/04/2022 11:58:52 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-049 (HMO-POS)	01	02		1			H5619	049	0	2023	Indianapolis Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	050	0	1	01	01	H5619_050_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:37:42 PM Eastern Daylight Time	08/03/2022 04:24:31 PM Eastern Daylight Time	07/30/2022 08:48:46 AM Eastern Daylight Time			08/04/2022 11:58:52 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-050 (HMO)	01	01		1			H5619	050	0	2023	Evansville Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H5619_051_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:38:09 PM Eastern Daylight Time	08/03/2022 04:24:03 PM Eastern Daylight Time	07/30/2022 08:49:10 AM Eastern Daylight Time			08/04/2022 11:58:52 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-051 (HMO-POS)	01	02		1			H5619	051	0	2023	Fort Wayne Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	052	0	1	01	01	H5619_052_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:38:24 PM Eastern Daylight Time	08/03/2022 04:26:25 PM Eastern Daylight Time	07/30/2022 08:49:36 AM Eastern Daylight Time			08/04/2022 11:58:52 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-052 (HMO)	01	01		1			H5619	052	0	2023	South Bend Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H5619_053_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:38:41 PM Eastern Daylight Time	08/03/2022 04:31:40 PM Eastern Daylight Time	07/30/2022 08:50:00 AM Eastern Daylight Time			08/04/2022 11:58:52 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-053 (HMO-POS)	01	02		1			H5619	053	0	2023	Lake and Porter County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 02:39:01 PM Eastern Daylight Time	08/03/2022 04:26:55 PM Eastern Daylight Time	07/30/2022 08:50:26 AM Eastern Daylight Time			08/04/2022 11:58:52 AM 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	2023	Select counties in Indiana		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 02:39:17 PM Eastern Daylight Time	08/03/2022 04:28:49 PM Eastern Daylight Time	07/30/2022 08:50:52 AM Eastern Daylight Time			08/04/2022 11:58:52 AM 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	2023	Select counties in Kentucky and Indiana		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 02:59:22 PM Eastern Daylight Time	08/03/2022 03:41:47 PM Eastern Daylight Time	07/30/2022 08:51:16 AM Eastern Daylight Time			08/04/2022 12:09:47 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	2023	Select Counties in WA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 02:59:37 PM Eastern Daylight Time	08/03/2022 03:44:35 PM Eastern Daylight Time	07/30/2022 08:51:42 AM Eastern Daylight Time			08/04/2022 12:09:47 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	2023	King County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	059	0	1	01	01	H5619_059_0	3	1			1		1	05/30/2022	2023.01	05/30/2022 03:14:20 PM Eastern Daylight Time	08/03/2022 03:42:14 PM Eastern Daylight Time	07/30/2022 08:52:08 AM Eastern Daylight Time			08/04/2022 12:09:47 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	2023	Select Counties in WA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 02:59:55 PM Eastern Daylight Time	08/03/2022 03:42:42 PM Eastern Daylight Time	07/30/2022 08:52:32 AM Eastern Daylight Time			08/04/2022 12:09:47 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	2023	Spokane County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/30/2022	2023.01	05/30/2022 09:26:34 AM Eastern Daylight Time	08/03/2022 03:45:57 PM Eastern Daylight Time	07/30/2022 08:52:58 AM Eastern Daylight Time			08/04/2022 12:09:47 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	2023	Select Counties in WA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	063	0	1	01	01	H5619_063_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:00:15 PM Eastern Daylight Time	08/03/2022 03:48:14 PM Eastern Daylight Time	07/30/2022 08:53:22 AM Eastern Daylight Time			08/04/2022 12:09:47 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	2023	Snohomish County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 03:00:28 PM Eastern Daylight Time	08/03/2022 03:48:42 PM Eastern Daylight Time	07/30/2022 08:53:48 AM Eastern Daylight Time			08/04/2022 12:09:47 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	2023	Thurston County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	065	0	1	01	01	H5619_065_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:10:50 AM Eastern Daylight Time	08/03/2022 03:38:53 PM Eastern Daylight Time	07/30/2022 08:54:14 AM Eastern Daylight Time			08/04/2022 05:47:42 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	2023	New Hampshire		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	066	0	1	01	01	H5619_066_0	3	1			1		0	08/01/2022	2023.01	08/01/2022 07:52:19 PM Eastern Daylight Time	08/03/2022 03:39:54 PM Eastern Daylight Time	07/30/2022 08:54:38 AM Eastern Daylight Time			08/04/2022 03:02:51 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	2023	Maine		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H5619_069_0	3	1			1		1	05/31/2022	2023.01	05/31/2022 01:36:03 PM Eastern Daylight Time	08/03/2022 03:45:19 PM Eastern Daylight Time	07/30/2022 08:55:04 AM Eastern Daylight Time			08/04/2022 11:21:39 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-069 (HMO-POS)	01	02		1			H5619	069	0	2023	Select Counties in Arkansas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	071	0	1	01	01	H5619_071_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 04:19:35 PM Eastern Daylight Time	08/03/2022 04:31:13 PM Eastern Daylight Time	07/30/2022 08:55:28 AM Eastern Daylight Time			08/04/2022 04:53:23 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	2023	Lexington Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 03:28:51 PM Eastern Daylight Time	08/03/2022 04:40:23 PM Eastern Daylight Time	07/30/2022 08:55:54 AM Eastern Daylight Time			08/04/2022 04:53:23 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	2023	Central Kentucky Area		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 04:17:57 PM Eastern Daylight Time	08/03/2022 04:41:11 PM Eastern Daylight Time	07/30/2022 08:56:18 AM Eastern Daylight Time			08/04/2022 04:53:23 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	2023	Clark, Floyd and Harrison counties		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/29/2022	2023.01	05/29/2022 09:27:39 PM Eastern Daylight Time	08/03/2022 03:40:24 PM Eastern Daylight Time	07/30/2022 08:56:44 AM Eastern Daylight Time			08/04/2022 11:06:38 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-077 (HMO)	01	01		1			H5619	077	0	2023	Select Counties in ID		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/29/2022	2023.01	05/29/2022 09:28:47 PM Eastern Daylight Time	08/03/2022 03:41:19 PM Eastern Daylight Time	07/30/2022 08:57:08 AM Eastern Daylight Time			08/04/2022 11:06:38 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-078 (HMO)	01	01		1			H5619	078	0	2023	Select Counties in ID		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 02:58:54 PM Eastern Daylight Time	08/03/2022 05:25:52 PM Eastern Daylight Time	07/30/2022 08:57:32 AM Eastern Daylight Time			08/04/2022 03:56:59 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	2023	South Carolina		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 08:05:28 AM Eastern Daylight Time	08/03/2022 05:26:18 PM Eastern Daylight Time	07/30/2022 08:57:58 AM Eastern Daylight Time			08/04/2022 03:48:12 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	2023	Charleston Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	087	0	1	01	01	H5619_087_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 03:02:02 PM Eastern Daylight Time	08/03/2022 05:27:09 PM Eastern Daylight Time	07/30/2022 08:58:22 AM Eastern Daylight Time			08/04/2022 03:56:59 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	087	0	2023	Upstate South Carolina		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:37:31 PM Eastern Daylight Time	08/03/2022 03:49:51 PM Eastern Daylight Time	07/30/2022 08:58:48 AM Eastern Daylight Time			08/04/2022 01:00:25 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	2023	Birmingham Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:37:56 PM Eastern Daylight Time	08/03/2022 03:50:53 PM Eastern Daylight Time	07/30/2022 08:59:14 AM Eastern Daylight Time			08/04/2022 01:05:34 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	2023	Mobile Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	090	0	1	01	01	H5619_090_0	3	1			1		1	05/28/2022	2023.01	05/28/2022 01:10:24 PM Eastern Daylight Time	08/03/2022 03:51:57 PM Eastern Daylight Time	07/30/2022 08:59:38 AM Eastern Daylight Time			08/04/2022 01:05:34 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	2023	Select VA Counties in the Tri-Cities Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	091	0	1	01	01	H5619_091_0	3	1			1		1	05/30/2022	2023.01	05/30/2022 10:07:14 AM Eastern Daylight Time	08/03/2022 03:53:01 PM Eastern Daylight Time	07/30/2022 09:00:04 AM Eastern Daylight Time			08/04/2022 01:05:34 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	2023	Select VA Counties in the Tri-Cities Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 09:45:37 AM Eastern Daylight Time	08/03/2022 03:54:16 PM Eastern Daylight Time	07/30/2022 09:00:30 AM Eastern Daylight Time			08/04/2022 01:05:34 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	2023	Greater Alabama		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:38:13 PM Eastern Daylight Time	08/03/2022 03:55:18 PM Eastern Daylight Time	07/30/2022 09:00:56 AM Eastern Daylight Time			08/04/2022 01:05:34 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	2023	Huntsville Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	095	0	1	01	01	H5619_095_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:38:29 PM Eastern Daylight Time	08/03/2022 04:02:52 PM Eastern Daylight Time	07/30/2022 09:01:20 AM Eastern Daylight Time			08/04/2022 01:05:34 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	2023	Select VA Counties in the Tri-Cities Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 03:00:43 PM Eastern Daylight Time	08/03/2022 03:49:37 PM Eastern Daylight Time	07/30/2022 09:01:46 AM Eastern Daylight Time			08/04/2022 12:09:47 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	2023	Kitsap County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	100	0	1	01	01	H5619_100_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 03:01:07 PM Eastern Daylight Time	08/03/2022 03:49:09 PM Eastern Daylight Time	07/30/2022 09:02:12 AM Eastern Daylight Time			08/04/2022 12:09:47 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	2023	Pierce County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H5619_111_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:00:39 PM Eastern Daylight Time	08/03/2022 03:45:51 PM Eastern Daylight Time	07/30/2022 09:02:36 AM Eastern Daylight Time			08/04/2022 11:21:39 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-111 (HMO-POS)	01	02		1			H5619	111	0	2023	Arkansas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:39:01 PM Eastern Daylight Time	08/03/2022 04:08:44 PM Eastern Daylight Time	07/30/2022 09:03:02 AM Eastern Daylight Time			08/04/2022 01:05:34 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	2023	Select Counties in Alabama		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:22:19 PM Eastern Daylight Time	08/03/2022 04:47:30 PM Eastern Daylight Time	07/30/2022 09:03:26 AM Eastern Daylight Time			08/04/2022 05:11:45 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	2023	Select Counties in West Virginia and Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 03:01:30 PM Eastern Daylight Time	08/03/2022 03:50:59 PM Eastern Daylight Time	07/30/2022 09:03:52 AM Eastern Daylight Time			08/04/2022 12:15:39 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	2023	Select Counties in WA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:24:52 AM Eastern Daylight Time	08/03/2022 04:13:17 PM Eastern Daylight Time	07/30/2022 09:04:18 AM Eastern Daylight Time			08/04/2022 01:41:56 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	2023	Kern County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:25:22 AM Eastern Daylight Time	08/03/2022 04:15:45 PM Eastern Daylight Time	07/30/2022 09:04:44 AM Eastern Daylight Time			08/04/2022 01:41:56 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	2023	San Luis Obispo County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/28/2022	2023.01	05/28/2022 10:35:18 AM Eastern Daylight Time	07/18/2022 06:41:13 PM Eastern Daylight Time				07/20/2022 02:46:59 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H5619	120	0	2023	Los Angeles, Orange and San Diego counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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				0	0	05/28/2022	2023.01	05/28/2022 09:47:13 AM Eastern Daylight Time	07/18/2022 06:41:45 PM Eastern Daylight Time				07/20/2022 02:19:52 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H5619	121	0	2023	Select Counties in California		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1		1	05/31/2022	2023.01	05/31/2022 01:38:31 PM Eastern Daylight Time	08/03/2022 03:51:00 PM Eastern Daylight Time	07/30/2022 09:05:08 AM Eastern Daylight Time			08/04/2022 11:21:39 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-122 (HMO)	01	01		1			H5619	122	0	2023	Select Counties in Arkansas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H5619_123_0	3	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 12:08:55 PM Eastern Daylight Time	08/03/2022 03:51:31 PM Eastern Daylight Time	07/30/2022 09:05:34 AM Eastern Daylight Time			08/04/2022 11:21:39 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP)	01	02		1			H5619	123	0	2023	Select Counties in Arkansas		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 01:03:54 PM Eastern Daylight Time	08/03/2022 04:53:30 PM Eastern Daylight Time	07/30/2022 09:06:00 AM Eastern Daylight Time			08/04/2022 05:11:45 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	2023	Select Counties in West Virginia		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:48:45 PM Eastern Daylight Time	08/03/2022 04:50:29 PM Eastern Daylight Time	07/30/2022 09:06:26 AM Eastern Daylight Time			08/04/2022 04:53:23 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	2023	Bowling Green Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	07/07/2022	2023.01	07/07/2022 10:25:06 AM Eastern Daylight Time	08/03/2022 04:19:43 PM Eastern Daylight Time	07/30/2022 09:06:52 AM Eastern Daylight Time			08/04/2022 01:49:51 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	2023	Santa Barbara (partial) and Ventura counties	Santa Barbara (partial) County	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 10:56:35 AM Eastern Daylight Time	08/03/2022 04:20:14 PM Eastern Daylight Time	07/30/2022 09:07:16 AM Eastern Daylight Time			08/04/2022 01:12:17 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	2023	Santa Barbara (partial) and Ventura counties	Ventura County	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 10:57:34 AM Eastern Daylight Time	08/03/2022 04:16:15 PM Eastern Daylight Time	07/30/2022 09:07:42 AM Eastern Daylight Time			08/04/2022 01:12:17 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	2023	San Diego County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	05/30/2022	2023.01	05/30/2022 09:28:30 AM Eastern Daylight Time	08/03/2022 03:52:21 PM Eastern Daylight Time	07/30/2022 09:08:08 AM Eastern Daylight Time			08/04/2022 12:15:39 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	2023	Select Counties in WA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		0	08/01/2022	2023.01	08/01/2022 03:01:55 PM Eastern Daylight Time	08/03/2022 03:53:18 PM Eastern Daylight Time	07/30/2022 09:08:34 AM Eastern Daylight Time			08/04/2022 12:15:39 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	2023	Select Counties in WA		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:45:00 PM Eastern Daylight Time	08/03/2022 04:15:56 PM Eastern Daylight Time	07/30/2022 09:08:58 AM Eastern Daylight Time			08/04/2022 03:15:59 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	2023	Roanoke		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 03:47:35 PM Eastern Daylight Time	08/03/2022 03:58:02 PM Eastern Daylight Time	07/30/2022 09:09:24 AM Eastern Daylight Time			08/04/2022 12:37:53 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	2023	Select Counties in WA	Select Counties in WA	2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/17/2022	2023.01	08/17/2022 04:06:18 PM Eastern Daylight Time	08/03/2022 03:59:16 PM Eastern Daylight Time	07/30/2022 09:09:50 AM Eastern Daylight Time			08/17/2022 04:36:48 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	2023	Select Counties in WA	Snohomish County	2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	2	1	1		0	08/17/2022	2023.01	08/17/2022 04:07:03 PM Eastern Daylight Time	08/03/2022 03:59:56 PM Eastern Daylight Time	07/30/2022 09:10:14 AM Eastern Daylight Time			08/17/2022 04:36:48 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	2023	Select Counties in WA	Select Counties in WA	2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 09:23:09 AM Eastern Daylight Time	08/03/2022 04:00:23 PM Eastern Daylight Time	07/30/2022 09:10:40 AM Eastern Daylight Time			08/04/2022 12:37:53 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	2023	Select Counties in WA	Select Counties in WA	2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	06/02/2022	2023.01	06/02/2022 06:48:13 PM Eastern Daylight Time	08/03/2022 03:49:48 PM Eastern Daylight Time	07/30/2022 09:11:06 AM Eastern Daylight Time			08/04/2022 05:47:42 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	2023	New Hampshire and Select Counties in Maine		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/28/2022	2023.01	05/28/2022 09:51:27 AM Eastern Daylight Time	08/03/2022 04:20:44 PM Eastern Daylight Time	07/30/2022 09:11:30 AM Eastern Daylight Time			08/04/2022 01:46:44 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H5619	138	0	2023	Contra Costa County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:45:27 PM Eastern Daylight Time	08/03/2022 04:17:52 PM Eastern Daylight Time	07/30/2022 09:11:56 AM Eastern Daylight Time			08/04/2022 03:15:59 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	2023	Richmond	Richmond Collar	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:45:51 PM Eastern Daylight Time	08/03/2022 04:18:22 PM Eastern Daylight Time	07/30/2022 09:12:20 AM Eastern Daylight Time			08/04/2022 03:15:59 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	2023	Richmond	Richmond Core	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:46:57 PM Eastern Daylight Time	08/03/2022 04:18:52 PM Eastern Daylight Time	07/30/2022 09:12:46 AM Eastern Daylight Time			08/04/2022 03:15:59 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	2023	Tidewater	Tidewater Collar	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:47:26 PM Eastern Daylight Time	08/03/2022 04:19:21 PM Eastern Daylight Time	07/30/2022 09:13:12 AM Eastern Daylight Time			08/04/2022 03:15:59 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	2023	Tidewater	Tidewater Core	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H5619_141_0	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 01:01:47 PM Eastern Daylight Time	08/03/2022 04:06:07 PM Eastern Daylight Time	07/30/2022 09:13:36 AM Eastern Daylight Time			08/04/2022 11:21:39 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO-POS C-SNP)	01	02		1			H5619	141	0	2023	Select Counties in Arkansas		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 03:04:04 PM Eastern Daylight Time	08/03/2022 04:01:45 PM Eastern Daylight Time	07/30/2022 09:14:02 AM Eastern Daylight Time			08/04/2022 12:37:53 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	2023	Spokane County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	145	0	1	01	01	H5619_145_0	5	1		1	1		1	07/21/2022	2023.01	07/21/2022 12:50:53 PM Eastern Daylight Time	08/03/2022 04:22:02 PM Eastern Daylight Time	07/30/2022 09:14:26 AM Eastern Daylight Time			08/04/2022 04:33:47 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	145	0	2023	Virginia		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	146	0	1	01	01	H5619_146_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:03:02 AM Eastern Daylight Time	08/03/2022 04:23:41 PM Eastern Daylight Time	07/30/2022 09:14:52 AM Eastern Daylight Time			08/04/2022 01:12:17 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-146 (HMO)	01	01		1			H5619	146	0	2023	Los Angeles and Orange Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	147	0	1	01	01	H5619_147_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:03:22 AM Eastern Daylight Time	08/03/2022 04:24:10 PM Eastern Daylight Time	07/30/2022 09:15:18 AM Eastern Daylight Time			08/04/2022 01:12:17 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-147 (HMO)	01	01		1			H5619	147	0	2023	Napa and Marin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	148	0	1	01	01	H5619_148_0	3	1			1		1	05/29/2022	2023.01	05/29/2022 06:51:36 PM Eastern Daylight Time	08/03/2022 04:25:09 PM Eastern Daylight Time	07/30/2022 09:15:42 AM Eastern Daylight Time			08/04/2022 01:46:44 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-148 (HMO)	01	01		1			H5619	148	0	2023	Select Counties In California		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	149	0	1	01	01	H5619_149_0	3	1			1		1	05/29/2022	2023.01	05/29/2022 08:27:54 PM Eastern Daylight Time	08/03/2022 04:24:39 PM Eastern Daylight Time	07/30/2022 09:16:08 AM Eastern Daylight Time			08/04/2022 01:46:44 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-149 (HMO)	01	01		1			H5619	149	0	2023	Los Angeles and Orange Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	150	0	1	01	01	H5619_150_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:25:43 AM Eastern Daylight Time	08/03/2022 04:23:11 PM Eastern Daylight Time	07/30/2022 09:16:34 AM Eastern Daylight Time			08/04/2022 01:41:56 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-150 (HMO)	01	01		1			H5619	150	0	2023	Select Counties in California		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	151	0	1	01	01	H5619_151_0	2	1			2	0	0	05/28/2022	2023.01	05/28/2022 09:27:03 AM Eastern Daylight Time	07/18/2022 05:31:43 PM Eastern Daylight Time				07/20/2022 01:44:10 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H5619	151	0	2023	Southwest Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5619	152	0	1	01	01	H5619_152_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:07:32 PM Eastern Daylight Time	08/03/2022 05:43:04 PM Eastern Daylight Time	07/30/2022 09:16:58 AM Eastern Daylight Time			08/04/2022 03:38:14 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-152 (HMO)	01	01		1			H5619	152	0	2023	South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	153	0	1	01	01	H5619_153_0	3	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 10:39:55 AM Eastern Daylight Time	08/03/2022 05:47:33 PM Eastern Daylight Time	07/30/2022 09:17:24 AM Eastern Daylight Time			08/04/2022 03:38:14 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-153 (HMO D-SNP)	01	01		1			H5619	153	0	2023	Select counties in South Carolina		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/27/2022	2023.01	05/27/2022 06:07:03 PM Eastern Daylight Time					05/27/2022 06:14:54 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	802	0	2023	Select Counties in Multi States		1	1254	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 06:08:50 PM Eastern Daylight Time					05/27/2022 06:14:54 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	803	0	2023	Select Counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/27/2022	2023.01	05/27/2022 06:11:37 PM Eastern Daylight Time					05/27/2022 06:14:54 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	805	0	2023	Select Counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 06:14:27 PM Eastern Daylight Time					05/27/2022 06:14:54 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	806	0	2023	Select Counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:32:11 PM Pacific Daylight Time	08/04/2022 06:01:14 PM Pacific Daylight Time	08/01/2022 10:34:04 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 02:05:05 PM Pacific Daylight Time	08/04/2022 06:01:42 PM Pacific Daylight Time	08/01/2022 10:34:36 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:32:34 PM Pacific Daylight Time	08/04/2022 06:02:10 PM Pacific Daylight Time	08/01/2022 10:35:08 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	010	0	1	01	01	H5628_010_0	7	1					1	08/04/2022	2023.01	08/04/2022 02:07:00 PM Pacific Daylight Time	08/04/2022 06:02:38 PM Pacific Daylight Time	08/01/2022 02:28:44 PM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	Select Counties in Idaho		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	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:07:50 PM Pacific Daylight Time	08/04/2022 06:03:06 PM Pacific Daylight Time	08/01/2022 10:36:08 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:33:03 PM Pacific Daylight Time	08/04/2022 06:03:34 PM Pacific Daylight Time	08/01/2022 10:36:40 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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						06/01/2022	2023.01	06/01/2022 11:03:50 AM Pacific Daylight Time		06/01/2022 11:21:18 AM Pacific Daylight Time			06/01/2022 11:22:19 AM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE 1833PACENOW (PACE)	08	20		1			H5629	001	0	2023	Serving all San Diego County with many locations		2		2			2									stpaulspace.org	stpaulspace.org	https://www.stpaulspace.org/about/doctor-profiles/											(619)677-3862				(619)677-3862										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H5629	002	0	1	20	08	H5629_002_0	1	1						06/01/2022	2023.01	06/01/2022 11:04:07 AM Pacific Daylight Time		06/01/2022 11:21:18 AM Pacific Daylight Time			06/01/2022 11:22:19 AM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE  1833PACENOW (PACE)	08	20		1			H5629	002	0	2023	Serving all San Diego County with many locations		2		2			2									stpaulspace.org	stpaulspace.org	https://www.stpaulspace.org/about/doctor-profiles/											(619)271-7100	1059			(619)271-7100										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H5644	801	0	1	01	01	H5644_801_0	3	1				0	0	05/20/2022	2023.01	05/20/2022 11:34:17 AM Eastern Daylight Time					06/02/2022 10:18:05 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network Health Medicare Employer (HMO)	01	01		1			H5644	801	0	2023	Southeast 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										2					2					2	2			
H5644	802	0	1	01	01	H5644_802_0	3	1						05/20/2022	2023.01	05/20/2022 11:35:19 AM Eastern Daylight Time					06/02/2022 10:18:05 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network Health Medicare Employer CY Pharmacy (HMO)	01	01		1			H5644	802	0	2023	Southeast 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		2					2					2	2			
H5644	803	0	1	01	01	H5644_803_0	3	1						05/23/2022	2023.01	05/23/2022 09:33:14 AM Eastern Daylight Time					06/02/2022 10:18:05 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network Health Medicare Employer Pharmacy (HMO)	01	01		1			H5644	803	0	2023	Southeast 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		2					2					2	2			
H5649	001	0	1	01	01	H5649_001_0	7	1					0	08/03/2022	2023.01	08/03/2022 06:30:29 PM Central Daylight Time	08/04/2022 02:30:05 PM Central Daylight Time	08/04/2022 02:30:21 PM Central Daylight Time			08/04/2022 03:20:27 PM Central 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	2023	Counties:  LA, SB, RS, OC		2		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	8	1	2	1			0	08/03/2022	2023.01	08/03/2022 06:35:33 PM Central Daylight Time	08/04/2022 02:30:05 PM Central Daylight Time	08/04/2022 02:30:21 PM Central Daylight Time			08/04/2022 03:20:27 PM Central 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	2023	Counties: LA and SB		2		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	006	0	1	01	01	H5649_006_0	7	1		1			1	08/03/2022	2023.01	08/03/2022 05:08:40 PM Central Daylight Time	08/04/2022 02:30:05 PM Central Daylight Time	08/04/2022 02:30:21 PM Central Daylight Time			08/04/2022 03:20:27 PM Central 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	2023	Counties:  ALA, CC, FRE, LA, ORA, SBD, SJQ, SCL		2		2			1	4			00000000000000000010000					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	8	1						08/03/2022	2023.01	08/03/2022 05:09:04 PM Central Daylight Time	08/04/2022 02:30:05 PM Central Daylight Time	08/04/2022 02:30:21 PM Central Daylight Time			08/04/2022 03:20:27 PM Central 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	2023	Ventura County		2		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	8	1	2	1			0	08/03/2022	2023.01	08/03/2022 06:38:18 PM Central Daylight Time	08/04/2022 02:30:05 PM Central Daylight Time	08/04/2022 02:30:21 PM Central Daylight Time			08/04/2022 03:20:27 PM Central 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	2023	Ventura County		2		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	7	1						08/03/2022	2023.01	08/03/2022 05:09:34 PM Central Daylight Time	08/04/2022 02:30:06 PM Central Daylight Time	08/04/2022 02:30:21 PM Central Daylight Time			08/04/2022 03:20:27 PM Central 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	2023	San Mateo County		2		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	8	1					0	08/03/2022	2023.01	08/03/2022 05:09:54 PM Central Daylight Time	08/04/2022 02:30:06 PM Central Daylight Time	08/04/2022 02:30:21 PM Central Daylight Time			08/04/2022 03:20:27 PM Central 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	2023	Counties: LA, ORA, RS, SBD		2		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	020	1	1	01	01	H5649_020_1	7	1					0	08/03/2022	2023.01	08/03/2022 05:10:21 PM Central Daylight Time	08/04/2022 02:30:06 PM Central Daylight Time	08/04/2022 02:30:21 PM Central Daylight Time			08/04/2022 03:20:27 PM Central Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Premier Plan I (HMO)	01	01		1			H5649	020	1	2023	Counties: ALA, CC, FRE, LA, ORA, RS, SBD, SJQ, SCL	LA, CC, FRE, SJQ, SCL	2		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	020	2	1	01	01	H5649_020_2	7	1					0	08/03/2022	2023.01	08/03/2022 05:10:55 PM Central Daylight Time	08/04/2022 02:30:06 PM Central Daylight Time	08/04/2022 02:30:21 PM Central Daylight Time			08/04/2022 03:20:27 PM Central Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Premier Plan I (HMO)	01	01		1			H5649	020	2	2023	Counties: ALA, CC, FRE, LA, ORA, RS, SBD, SJQ, SCL	Orange, Riverside, San Bernardino	2		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	021	1	1	01	01	H5649_021_1	7	1					0	08/03/2022	2023.01	08/03/2022 05:11:31 PM Central Daylight Time	08/04/2022 02:30:06 PM Central Daylight Time	08/04/2022 02:30:22 PM Central Daylight Time			08/04/2022 03:20:27 PM Central Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Premier Plan II (HMO)	01	01		1			H5649	021	1	2023	Counties: ALA, CC, FRE, LA, ORA, RS, SBD, SJQ, SCL	Orange, Riverside, San Bernardino	2		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	021	2	1	01	01	H5649_021_2	7	1					0	08/03/2022	2023.01	08/03/2022 05:11:48 PM Central Daylight Time	08/04/2022 02:30:06 PM Central Daylight Time	08/04/2022 02:30:22 PM Central Daylight Time			08/04/2022 03:20:27 PM Central Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Premier Plan II (HMO)	01	01		1			H5649	021	2	2023	Counties: ALA, CC, FRE, LA, ORA, RS, SBD, SJQ, SCL	ALA, CC, FRE, LA, SJQ, SCL	2		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	2	1					1	06/02/2022	2023.01	06/02/2022 11:04:24 AM Central Daylight Time	08/03/2022 11:02:53 AM Central Daylight Time	07/31/2022 03:30:51 AM Central Daylight Time			08/04/2022 05:16:25 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	2023	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC		2		2			2									www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5652	002	0	1	02	01	H5652_002_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 09:08:23 PM Central Daylight Time	06/01/2022 10:00:48 AM Central Daylight Time				06/02/2022 02:48:01 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	2023	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	4	1		1			1	08/04/2022	2023.01	08/04/2022 02:36:41 PM Central Daylight Time	08/03/2022 11:03:33 AM Central Daylight Time	07/31/2022 03:31:16 AM Central Daylight Time			08/04/2022 05:16:25 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	2023	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC		2		2			1	1	1							www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5652	004	0	1	02	01	H5652_004_0	2	1		1			1	05/31/2022	2023.01	05/31/2022 09:11:58 PM Central Daylight Time	08/03/2022 11:04:13 AM Central Daylight Time	07/31/2022 03:31:41 AM Central Daylight Time			08/04/2022 05:16:25 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	2023	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC		2		2			1	4			00011010000000000000000					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	2	1					1	05/31/2022	2023.01	05/31/2022 09:14:03 PM Central Daylight Time	08/03/2022 11:04:53 AM Central Daylight Time	07/31/2022 03:32:05 AM Central Daylight Time			08/04/2022 05:16:25 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	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 02:37:06 PM Central Daylight Time	08/03/2022 11:05:33 AM Central Daylight Time	07/31/2022 03:32:30 AM Central Daylight Time			08/04/2022 05:16:25 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	2023	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	9	1	2	1			0	06/06/2022	2023.01	06/06/2022 10:39:57 AM Central Daylight Time	08/01/2022 01:03:12 PM Central Daylight Time	08/01/2022 01:13:06 PM Central Daylight Time			08/01/2022 01:22:14 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	2023	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	5	1						07/14/2022	2023.01	07/14/2022 01:32:25 PM Pacific Daylight Time	08/04/2022 03:20:12 PM Pacific Daylight Time	08/04/2022 03:36:36 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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	6	1						08/01/2022	2023.01	08/01/2022 11:51:53 PM Pacific Daylight Time	08/04/2022 03:20:13 PM Pacific Daylight Time	08/04/2022 03:36:38 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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	6	1		1				07/14/2022	2023.01	07/14/2022 01:32:42 PM Pacific Daylight Time		08/04/2022 03:36:41 PM Pacific Daylight Time		08/04/2022 03:20:15 PM Pacific Daylight Time	08/19/2022 08:29:30 AM 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	2023	Greater Albuquerque MSA		2		2			1	4			00000000100000000000000					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	07/06/2022	2023.01	07/06/2022 09:57:26 AM SA Western Standard Time	06/06/2022 09:13:24 PM SA Western Standard Time				07/06/2022 03:31:52 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Basic (HMO)	01	01		1			H5774	003	0	2023	Puerto Rico		2		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	7d;7g;7j;8a1;8a2;8b1;	7f;
H5774	005	0	1	01	01	H5774_005_0	8	1			1		1	08/03/2022	2023.01	08/03/2022 04:14:48 PM SA Western Standard Time	08/03/2022 04:32:38 PM SA Western Standard Time	07/31/2022 12:44:04 PM SA Western Standard Time			08/05/2022 01:53:02 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Real (HMO)	01	01		1			H5774	005	0	2023	Puerto Rico		2		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;7j;8a1;8a2;8b1;	7f;
H5774	022	0	1	01	01	H5774_022_0	8	1		1	1		1	08/03/2022	2023.01	08/03/2022 03:38:21 PM SA Western Standard Time	08/03/2022 04:33:02 PM SA Western Standard Time	07/31/2022 12:44:24 PM SA Western Standard Time			08/05/2022 01:53:02 PM 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	2023	Puerto Rico		2		2			1	4			00000000000000000010000					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;7g;7j;8a1;8a2;8b1;18a;	18a1;18a2;
H5774	024	0	1	01	01	H5774_024_0	8	1	1	1	1		0	08/03/2022	2023.01	08/03/2022 03:36:41 PM SA Western Standard Time	08/03/2022 04:33:28 PM SA Western Standard Time	07/31/2022 12:44:46 PM SA Western Standard Time			08/05/2022 01:53:02 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	2023	Puerto Rico		2		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	08/03/2022	2023.01	08/03/2022 03:38:03 PM SA Western Standard Time	08/03/2022 04:33:54 PM SA Western Standard Time	07/31/2022 12:45:06 PM SA Western Standard Time			08/05/2022 01:53:02 PM 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	2023	Puerto Rico		2		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	8	1	1	1	1		0	08/03/2022	2023.01	08/03/2022 03:39:03 PM SA Western Standard Time	08/03/2022 04:34:16 PM SA Western Standard Time	07/31/2022 12:45:28 PM SA Western Standard Time			08/05/2022 01:53:02 PM 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	2023	Puerto Rico		2		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	08/03/2022	2023.01	08/03/2022 04:11:16 PM SA Western Standard Time	08/03/2022 04:34:44 PM SA Western Standard Time	07/31/2022 12:45:50 PM SA Western Standard Time			08/05/2022 01:53:02 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Magno (HMO-POS)	01	02		1			H5774	027	0	2023	Puerto Rico		2		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;7j;8b1;	
H5774	028	0	1	01	01	H5774_028_0	8	1	1	1	1		0	08/03/2022	2023.01	08/03/2022 04:21:38 PM SA Western Standard Time	08/03/2022 04:35:08 PM SA Western Standard Time	07/31/2022 12:46:10 PM SA Western Standard Time			08/05/2022 01:53:02 PM 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	2023	Puerto Rico		2		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	08/03/2022	2023.01	08/03/2022 03:38:59 PM SA Western Standard Time	08/03/2022 04:35:32 PM SA Western Standard Time	07/31/2022 12:46:32 PM SA Western Standard Time			08/05/2022 01:53:02 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Brillante (HMO-POS)	01	02		1			H5774	031	0	2023	Puerto Rico		2		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;7j;8b1;	
H5774	035	0	1	01	01	H5774_035_0	8	1	1	1	1		0	08/03/2022	2023.01	08/03/2022 03:39:26 PM SA Western Standard Time	08/03/2022 04:35:56 PM SA Western Standard Time	07/31/2022 12:46:52 PM SA Western Standard Time			08/05/2022 01:53:02 PM 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	2023	Puerto Rico		2		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	036	0	1	01	01	H5774_036_0	8	1	1	1	1		0	08/03/2022	2023.01	08/03/2022 03:40:45 PM SA Western Standard Time	08/03/2022 04:36:20 PM SA Western Standard Time	07/31/2022 12:47:14 PM SA Western Standard Time			08/05/2022 01:53:02 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Titan (HMO D-SNP)	01	01		1			H5774	036	0	2023	Puerto Rico		2		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	037	0	1	01	01	H5774_037_0	8	1			1		1	08/03/2022	2023.01	08/03/2022 04:12:20 PM SA Western Standard Time	08/03/2022 04:36:50 PM SA Western Standard Time	07/31/2022 12:47:34 PM SA Western Standard Time			08/05/2022 01:53:02 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	AhorroMax (HMO)	01	01		1			H5774	037	0	2023	Puerto Rico		2		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;7j;8a1;8a2;8b1;	7f;
H5774	038	0	1	01	01	H5774_038_0	7	1			1		1	08/03/2022	2023.01	08/03/2022 04:13:38 PM SA Western Standard Time	08/03/2022 04:37:18 PM SA Western Standard Time	07/31/2022 12:47:56 PM SA Western Standard Time			08/05/2022 01:53:02 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Enlace Plus (HMO)	01	01		1			H5774	038	0	2023	Puerto Rico		2		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;7j;8a1;8a2;8b1;	7f;
H5774	802	0	1	01	01	H5774_802_0	6	1				0	0	06/03/2022	2023.01	06/03/2022 02:56:50 PM SA Western Standard Time					06/06/2022 09:52:37 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal A (HMO)	01	01		1			H5774	802	0	2023	Puerto Rico		1	120	2			2									www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(888)620-1919		(888)620-1919										(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	6	1						06/03/2022	2023.01	06/03/2022 03:06:04 PM SA Western Standard Time					06/06/2022 09:52:37 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal B (HMO)	01	01		1			H5774	806	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 03:06:59 PM SA Western Standard Time					06/06/2022 09:52:37 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal C (HMO)	01	01		1			H5774	808	0	2023	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	809	0	1	02	01	H5774_809_0	7	1						06/17/2022	2023.01	06/17/2022 04:47:15 PM SA Western Standard Time					06/17/2022 04:48:33 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	2023	Puerto Rico		1	41196	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	2		2		1				
H5774	810	0	1	01	01	H5774_810_0	6	1						06/03/2022	2023.01	06/03/2022 03:08:48 PM SA Western Standard Time					06/06/2022 09:52:37 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal E (HMO)	01	01		1			H5774	810	0	2023	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	811	0	1	02	01	H5774_811_0	6	1						06/03/2022	2023.01	06/03/2022 03:02:34 PM SA Western Standard Time					06/06/2022 09:52:37 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	2023	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;7g;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;9b;11a;11b;16b;	2		1				
H5774	812	0	1	02	01	H5774_812_0	6	1						06/03/2022	2023.01	06/03/2022 03:03:19 PM SA Western Standard Time					06/06/2022 09:52:37 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	2023	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;7g;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;9b;11a;11b;16b;	2		2				
H5774	814	0	1	02	01	H5774_814_0	7	1						06/17/2022	2023.01	06/17/2022 04:47:41 PM SA Western Standard Time					06/17/2022 04:48:33 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	2023	Puerto Rico		1	388644	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;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;9b;11a;11b;16b;	2		2				
H5774	816	0	1	02	01	H5774_816_0	6	1						06/03/2022	2023.01	06/03/2022 03:05:50 PM SA Western Standard Time					06/06/2022 09:52:37 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	2023	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	6	1						06/03/2022	2023.01	06/03/2022 03:05:37 PM SA Western Standard Time					06/06/2022 09:52:37 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	2023	Puerto Rico		1	11004	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;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;11c;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;11c;15;16b;	2		2				
H5774	820	0	1	02	01	H5774_820_0	6	1						06/03/2022	2023.01	06/03/2022 03:06:25 PM SA Western Standard Time					06/06/2022 09:52:37 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	2023	Puerto Rico		1	7908	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	2		2		2				
H5774	821	0	1	02	01	H5774_821_0	6	1						06/03/2022	2023.01	06/03/2022 03:07:24 PM SA Western Standard Time					06/06/2022 09:52:37 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	2023	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;11c;15;16b;	2		1	2		2		2				
H5774	822	0	1	02	01	H5774_822_0	6	1						06/03/2022	2023.01	06/03/2022 03:07:50 PM SA Western Standard Time					06/06/2022 09:52:37 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD10 (HMO-POS)	01	02		1			H5774	822	0	2023	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	823	0	1	02	01	H5774_823_0	6	1						06/03/2022	2023.01	06/03/2022 03:07:11 PM SA Western Standard Time					06/06/2022 09:52:37 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD11 (HMO-POS)	01	02		1			H5774	823	0	2023	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	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		2				
H5774	824	0	1	02	01	H5774_824_0	6	1						06/03/2022	2023.01	06/03/2022 03:09:21 PM SA Western Standard Time					06/06/2022 09:52:37 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD12 (HMO-POS)	01	02		1			H5774	824	0	2023	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;7g;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;16b;	2		1	2		2		2				
H5774	825	0	1	02	01	H5774_825_0	6	1						06/03/2022	2023.01	06/03/2022 02:56:20 PM SA Western Standard Time					06/06/2022 09:52:37 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD13 (HMO-POS)	01	02		1			H5774	825	0	2023	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						08/01/2022	2023.01	08/01/2022 12:33:10 PM Eastern Daylight Time	08/03/2022 08:05:06 PM Eastern Daylight Time	07/30/2022 09:51:27 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select counties in IL		2		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						08/01/2022	2023.01	08/01/2022 12:34:07 PM Eastern Daylight Time	08/03/2022 08:06:12 PM Eastern Daylight Time	07/30/2022 09:51:58 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select counties in IL		2		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;7c;7d;7f;7g;7i;7j;7k;16b;17a;18a;	
H5779	008	0	1	01	01	H5779_008_0	4	1						05/26/2022	2023.01	05/26/2022 10:58:17 AM Eastern Daylight Time	08/03/2022 08:07:20 PM Eastern Daylight Time	07/30/2022 09:52:29 AM Eastern Daylight Time			08/04/2022 06:08:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H5779	008	0	2023	Select counties in IL		2		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	02	01	H5793_001_0	3	1			2			05/31/2022	2023.01	05/31/2022 01:03:20 PM Eastern Daylight Time	08/02/2022 01:39:03 PM Eastern Daylight Time	08/01/2022 12:41:28 AM Eastern Daylight Time			08/04/2022 08:45:32 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H5793	001	0	2023	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	4	1			2			08/02/2022	2023.01	08/02/2022 01:57:31 PM Eastern Daylight Time	08/02/2022 01:40:01 PM Eastern Daylight Time	08/01/2022 12:41:56 AM Eastern Daylight Time			08/04/2022 08:45:32 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H5793	010	0	2023	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	02	01	H5793_014_0	3	1			2			08/01/2022	2023.01	08/01/2022 06:53:12 PM Eastern Daylight Time	08/02/2022 01:40:58 PM Eastern Daylight Time	08/01/2022 12:42:22 AM Eastern Daylight Time			08/04/2022 08:45:32 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H5793	014	0	2023	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			08/01/2022	2023.01	08/01/2022 06:44:55 PM Eastern Daylight Time	08/02/2022 01:41:56 PM Eastern Daylight Time	08/01/2022 12:42:48 AM Eastern Daylight Time			08/04/2022 08:45:32 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H5793	015	0	2023	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	02	01	H5793_016_0	3	1			2			08/01/2022	2023.01	08/01/2022 06:54:14 PM Eastern Daylight Time	08/02/2022 01:43:02 PM Eastern Daylight Time	08/01/2022 12:43:16 AM Eastern Daylight Time			08/04/2022 08:45:32 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H5793	016	0	2023	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	7	1	2	1	1		0	05/27/2022	2023.01	05/27/2022 03:12:51 PM Eastern Daylight Time	08/02/2022 01:44:01 PM Eastern Daylight Time	08/01/2022 12:43:42 AM Eastern Daylight Time			08/04/2022 08:45:32 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	2023	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	02	01	H5793_018_0	4	1			2			08/01/2022	2023.01	08/01/2022 06:55:09 PM Eastern Daylight Time	08/02/2022 01:44:58 PM Eastern Daylight Time	08/01/2022 12:44:10 AM Eastern Daylight Time			08/04/2022 08:45:32 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H5793	018	0	2023	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	019	0	1	02	01	H5793_019_0	3	1			2			08/01/2022	2023.01	08/01/2022 06:55:35 PM Eastern Daylight Time	08/02/2022 01:46:04 PM Eastern Daylight Time	08/01/2022 12:44:38 AM Eastern Daylight Time			08/04/2022 06:28:48 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO-POS)	01	02		1			H5793	019	0	2023	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	801	0	1	01	01	H5793_801_0	1	1				0	0	05/26/2022	2023.01	05/26/2022 02:57:41 PM Eastern Daylight Time					06/02/2022 03:37:58 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5793	801	0	2023	Connecticut		1	280	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H5793	802	0	1	01	01	H5793_802_0	1	1						05/31/2022	2023.01	05/31/2022 08:54:22 AM Eastern Daylight Time					06/02/2022 03:37:58 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	2023	Connecticut		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H5810	001	0	1	01	01	H5810_001_0	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:33:27 PM Pacific Daylight Time	08/04/2022 06:04:00 PM Pacific Daylight Time	08/01/2022 10:37:10 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:33:53 PM Pacific Daylight Time	08/04/2022 06:04:30 PM Pacific Daylight Time	08/01/2022 10:37:44 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 02:13:04 PM Pacific Daylight Time	08/04/2022 06:04:56 PM Pacific Daylight Time	08/01/2022 10:38:16 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 02:13:41 PM Pacific Daylight Time	08/04/2022 06:05:24 PM Pacific Daylight Time	08/01/2022 03:28:10 PM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	016	0	1	01	01	H5810_016_0	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:34:26 PM Pacific Daylight Time	08/04/2022 06:05:52 PM Pacific Daylight Time	08/01/2022 10:39:20 AM Pacific Daylight Time			08/04/2022 10:48:33 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	016	0	2023	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			
H5822	001	0	1	20	08	H5822_001_0	1	1						06/02/2022	2023.01	06/02/2022 01:23:03 PM Central Daylight Time		06/02/2022 12:44:25 PM Central Daylight Time			06/02/2022 01:25:47 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	2023	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						06/02/2022	2023.01	06/02/2022 01:23:37 PM Central Daylight Time		06/02/2022 12:44:37 PM Central Daylight Time			06/02/2022 01:25:47 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	2023	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	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:15:55 PM Pacific Daylight Time	08/04/2022 06:06:22 PM Pacific Daylight Time	08/01/2022 03:29:22 PM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:16:48 PM Pacific Daylight Time	08/04/2022 06:06:50 PM Pacific Daylight Time	08/01/2022 03:30:20 PM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 02:17:30 PM Pacific Daylight Time	08/04/2022 06:07:18 PM Pacific Daylight Time	08/01/2022 10:41:00 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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			2	0	0	07/11/2022	2023.01	07/11/2022 01:20:25 PM Pacific Daylight Time	06/03/2022 01:14:35 PM Pacific Daylight Time				07/13/2022 01:11:51 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 No Rx Plan (HMO)	01	01		1			H5826	006	0	2023	Western Washington and Spokane Counties		2		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			2		0	07/11/2022	2023.01	07/11/2022 01:13:51 PM Pacific Daylight Time	08/04/2022 10:11:28 AM Pacific Daylight Time	07/29/2022 02:07:00 PM Pacific Daylight Time			08/04/2022 04:33:05 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	2023	Western Washington and Spokane Counties		2		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			2		0	07/11/2022	2023.01	07/11/2022 01:15:21 PM Pacific Daylight Time	08/04/2022 10:14:56 AM Pacific Daylight Time	07/29/2022 02:08:33 PM Pacific Daylight Time			08/04/2022 04:33:05 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	2023	Eastern and Western Washington State		2		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	5	1			2		0	08/04/2022	2023.01	08/04/2022 11:23:17 AM Pacific Daylight Time	08/04/2022 10:16:26 AM Pacific Daylight Time	07/29/2022 02:09:19 PM Pacific Daylight Time			08/04/2022 04:33:05 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	2023	Eastern and Western Washington State		2		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	6	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:25:32 AM Pacific Daylight Time	08/04/2022 10:19:32 AM Pacific Daylight Time	07/29/2022 02:10:20 PM Pacific Daylight Time			08/04/2022 04:33:05 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	2023	Eastern and Western Washington State		2		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			2		0	08/04/2022	2023.01	08/04/2022 11:34:32 AM Pacific Daylight Time	08/04/2022 10:22:02 AM Pacific Daylight Time	07/29/2022 02:11:21 PM Pacific Daylight Time			08/04/2022 04:33:05 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	2023	Eastern and Western Washington State		2		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	08/01/2022	2023.01	08/01/2022 04:00:36 PM Eastern Daylight Time	08/04/2022 06:17:11 PM Eastern Daylight Time	08/04/2022 06:30:48 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 12:49:51 PM Eastern Daylight Time	08/04/2022 06:17:12 PM Eastern Daylight Time	08/04/2022 06:30:50 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	6	1			2		1	08/01/2022	2023.01	08/01/2022 04:35:13 PM Eastern Daylight Time	08/04/2022 06:17:13 PM Eastern Daylight Time	08/04/2022 06:30:53 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1			1		0	08/01/2022	2023.01	08/01/2022 04:36:02 PM Eastern Daylight Time	08/04/2022 06:17:15 PM Eastern Daylight Time	08/04/2022 06:30:56 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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			
H5843	001	0	1	01	01	H5843_001_0	8	1			1		1	08/17/2022	2023.01	08/17/2022 04:57:41 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time			08/17/2022 05:21:00 PM US Mountain Standard Time	BANNER HEALTH PLAN, INC.	Banner Medicare Advantage Prime	www.bannerhealth.com/medicare/	Banner Medicare Advantage Prime (HMO)	01	01		1			H5843	001	0	2023	Maricopa, Pinal Counties		2		2			2									www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	(844)549-1857		(602)462-0831		(844)549-1858		(602)536-7513		(844)549-1857		(602)462-0831		(844)549-1858		(602)536-7513		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5843	002	0	1	01	01	H5843_002_0	9	1			1		1	08/17/2022	2023.01	08/17/2022 05:01:05 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time			08/17/2022 05:21:00 PM US Mountain Standard Time	BANNER HEALTH PLAN, INC.	Banner Medicare Advantage Prime	www.bannerhealth.com/medicare/	Banner Medicare Advantage Prime (HMO)	01	01		1			H5843	002	0	2023	Pima and Santa Cruz Counties		2		2			2									www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	(844)549-1857		(602)462-0831		(844)549-1858		(602)536-7513		(844)549-1857		(602)462-0831		(844)549-1858		(602)536-7513		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5843	005	0	1	01	01	H5843_005_0	9	1			1		1	08/18/2022	2023.01	08/18/2022 11:26:41 AM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time			08/18/2022 11:41:26 AM US Mountain Standard Time	BANNER HEALTH PLAN, INC.	Banner Medicare Advantage Prime	www.bannerhealth.com/medicare/	Banner Medicare Advantage Prime (HMO)	01	01		1			H5843	005	0	2023	Yuma County		2		2			2									www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	(844)549-1857		(602)462-0831		(844)549-1858		(602)536-7513		(844)549-1857		(602)462-0831		(844)549-1858		(602)536-7513		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5852	001	0	1	01	01	H5852_001_0	5	1		1			1	08/09/2022	2023.01	08/09/2022 12:44:24 PM Pacific Daylight Time	08/09/2022 12:42:28 PM Pacific Daylight Time	08/09/2022 12:42:45 PM Pacific Daylight Time			08/09/2022 12:46:36 PM Pacific Daylight Time	AIDS HEALTHCARE FOUNDATION	AHF	www.php-ca.org	PHP (HMO C-SNP)	01	01		1			H5852	001	0	2023	Los Angeles County, California		2		2			1	4			00000000001000000000000					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			2		0	06/03/2022	2023.01	06/03/2022 10:05:34 AM Eastern Daylight Time	08/04/2022 06:21:21 PM Eastern Daylight Time	08/04/2022 06:38:44 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	1		0	05/31/2022	2023.01	05/31/2022 01:55:07 PM Eastern Daylight Time	08/04/2022 06:21:22 PM Eastern Daylight Time	08/04/2022 06:38:47 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	7	1			2		0	05/20/2022	2023.01	05/20/2022 12:08:01 PM Eastern Daylight Time	08/04/2022 06:21:24 PM Eastern Daylight Time	08/04/2022 06:38:49 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1			2		1	05/20/2022	2023.01	05/20/2022 12:10:44 PM Eastern Daylight Time	08/04/2022 06:21:25 PM Eastern Daylight Time	08/04/2022 06:38:52 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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			1		0	05/31/2022	2023.01	05/31/2022 01:59:47 PM Eastern Daylight Time	08/04/2022 06:21:26 PM Eastern Daylight Time	08/04/2022 06:38:55 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	7	1		1	2		0	08/02/2022	2023.01	08/02/2022 12:53:20 AM Pacific Daylight Time		08/04/2022 03:36:44 PM Pacific Daylight Time		08/04/2022 03:20:16 PM Pacific Daylight Time	08/19/2022 08:29:30 AM 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	2023	Select Counties in Connecticut		2		2			1	4			00000000100000000000000					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	05/31/2022	2023.01	05/31/2022 02:03:37 PM Eastern Daylight Time	08/04/2022 06:21:28 PM Eastern Daylight Time	08/04/2022 06:38:57 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:33:03 PM Pacific Daylight Time	08/04/2022 03:20:18 PM Pacific Daylight Time	08/04/2022 03:36:46 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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			2		0	08/01/2022	2023.01	08/01/2022 01:53:14 PM Eastern Daylight Time	08/04/2022 06:21:29 PM Eastern Daylight Time	08/04/2022 06:39:00 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	2	1						05/20/2022	2023.01	05/20/2022 11:05:11 AM Pacific Daylight Time					06/03/2022 10:44:24 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5854	803	0	1	01	01	H5854_803_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:05:45 AM Pacific Daylight Time					06/03/2022 10:44:24 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5854	806	0	2	01	01	H5854_806_0	2	1						05/20/2022	2023.01	05/20/2022 11:06:03 AM Pacific Daylight Time					06/03/2022 10:44:24 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5854	807	0	2	01	01	H5854_807_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:06:21 AM Pacific Daylight Time					06/03/2022 10:44:24 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5854	809	0	1	01	01	H5854_809_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:06:40 AM Pacific Daylight Time					06/03/2022 10:44:24 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5854	811	0	2	01	01	H5854_811_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 11:07:04 AM Pacific Daylight Time					06/03/2022 10:44:24 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H5859	001	0	1	02	01	H5859_001_0	13	1	2	1	1		0	10/25/2022	2023.01	10/25/2022 08:50:50 AM Pacific Daylight Time	08/03/2022 11:54:06 AM Pacific Daylight Time	08/03/2022 11:53:46 AM Pacific Daylight Time			10/25/2022 09:07:42 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	2023	Portland Metro Area, Jackson, Tillamook, Columbia		2		2			1	3		1					1	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	08/04/2022	2023.01	08/04/2022 02:50:32 PM Eastern Daylight Time	08/04/2022 01:24:57 PM Eastern Daylight Time				08/05/2022 03:53:44 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage Elements (HMO-POS)	01	02		1			H5883	001	1	2023	Michigan	Region 1	2		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	5	1				0	0	08/04/2022	2023.01	08/04/2022 01:46:14 PM Eastern Daylight Time	08/04/2022 01:24:58 PM Eastern Daylight Time				08/05/2022 03:53:44 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage Elements (HMO-POS)	01	02		1			H5883	001	2	2023	Michigan	Region 2	2		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	08/04/2022	2023.01	08/04/2022 01:59:30 PM Eastern Daylight Time	08/04/2022 01:24:58 PM Eastern Daylight Time				08/05/2022 03:53:44 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage Elements (HMO-POS)	01	02		1			H5883	001	3	2023	Michigan	Region 3	2		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	5	1				0	0	08/04/2022	2023.01	08/04/2022 02:00:02 PM Eastern Daylight Time	08/04/2022 01:24:58 PM Eastern Daylight Time				08/05/2022 03:53:44 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage Elements (HMO-POS)	01	02		1			H5883	001	4	2023	Michigan	Region 4	2		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	08/04/2022	2023.01	08/04/2022 02:00:34 PM Eastern Daylight Time	08/04/2022 01:24:59 PM Eastern Daylight Time				08/05/2022 03:53:44 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage Elements (HMO-POS)	01	02		1			H5883	001	5	2023	Michigan	Region 5	2		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	6	1					1	08/04/2022	2023.01	08/04/2022 02:01:19 PM Eastern Daylight Time	08/04/2022 01:24:59 PM Eastern Daylight Time	08/04/2022 01:24:59 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 1	2		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	6	1					1	08/04/2022	2023.01	08/04/2022 02:01:48 PM Eastern Daylight Time	08/04/2022 01:25:00 PM Eastern Daylight Time	08/04/2022 01:25:00 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 2	2		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	6	1					1	08/04/2022	2023.01	08/04/2022 02:24:43 PM Eastern Daylight Time	08/04/2022 01:25:01 PM Eastern Daylight Time	08/04/2022 01:25:01 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 3	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:25:11 PM Eastern Daylight Time	08/04/2022 01:25:01 PM Eastern Daylight Time	08/04/2022 01:25:02 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 4	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:25:42 PM Eastern Daylight Time	08/04/2022 01:25:02 PM Eastern Daylight Time	08/04/2022 01:25:02 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 5	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:26:11 PM Eastern Daylight Time	08/04/2022 01:25:03 PM Eastern Daylight Time	08/04/2022 01:25:03 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 1	2		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	6	1					1	08/04/2022	2023.01	08/04/2022 02:27:41 PM Eastern Daylight Time	08/04/2022 01:25:03 PM Eastern Daylight Time	08/04/2022 01:25:04 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 2	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:28:10 PM Eastern Daylight Time	08/04/2022 01:25:04 PM Eastern Daylight Time	08/04/2022 01:25:04 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 3	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:28:39 PM Eastern Daylight Time	08/04/2022 01:25:05 PM Eastern Daylight Time	08/04/2022 01:25:05 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 4	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:29:07 PM Eastern Daylight Time	08/04/2022 01:25:05 PM Eastern Daylight Time	08/04/2022 01:25:06 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 5	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:29:38 PM Eastern Daylight Time	08/04/2022 01:25:06 PM Eastern Daylight Time	08/04/2022 01:25:06 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Kalamazoo, Metro Detroit Area and Bay Region		2		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	5	1					0	08/04/2022	2023.01	08/04/2022 02:30:07 PM Eastern Daylight Time	08/04/2022 01:25:07 PM Eastern Daylight Time	08/04/2022 01:25:07 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Metro Detroit Area, Genesee, Livingston, St. Clair	Region 1	2		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	5	1					0	08/04/2022	2023.01	08/04/2022 02:30:34 PM Eastern Daylight Time	08/04/2022 01:25:07 PM Eastern Daylight Time	08/04/2022 01:25:08 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Metro Detroit Area, Genesee, Livingston, St. Clair	Region 2	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:50:56 PM Eastern Daylight Time	08/04/2022 01:25:08 PM Eastern Daylight Time	08/04/2022 01:25:09 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 1	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:31:38 PM Eastern Daylight Time	08/04/2022 01:25:09 PM Eastern Daylight Time	08/04/2022 01:25:10 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 2	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:32:06 PM Eastern Daylight Time	08/04/2022 01:25:11 PM Eastern Daylight Time	08/04/2022 01:25:11 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 3	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:32:37 PM Eastern Daylight Time	08/04/2022 01:25:12 PM Eastern Daylight Time	08/04/2022 01:25:12 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 4	2		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	5	1					1	08/04/2022	2023.01	08/04/2022 02:33:04 PM Eastern Daylight Time	08/04/2022 01:25:13 PM Eastern Daylight Time	08/04/2022 01:25:13 PM Eastern Daylight Time			08/05/2022 01:07:15 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	2023	Michigan	Region 5	2		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	015	0	1	01	01	H5883_015_0	6	1					1	08/04/2022	2023.01	08/04/2022 02:33:31 PM Eastern Daylight Time	08/04/2022 01:25:14 PM Eastern Daylight Time	08/04/2022 01:25:14 PM Eastern Daylight Time			08/05/2022 01:07:15 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage Local (HMO)	01	01		1			H5883	015	0	2023	Macomb, Oakland, Wayne		2		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	05/02/2022	2023.01	05/02/2022 01:27:39 PM Eastern Daylight Time					08/05/2022 03:53:44 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage (HMO-POS)	01	02		1			H5883	801	0	2023	Employer Group		1	295750	2			2									www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(800)450-3680		(800)450-3680										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;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;10a;15;	2		1				
H5883	805	0	1	02	01	H5883_805_0	4	1						05/02/2022	2023.01	05/02/2022 01:27:59 PM Eastern Daylight Time					08/05/2022 03:53:44 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage (HMO-POS)	01	02		1			H5883	805	0	2023	Employer Group		1	106965	2			2									www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(800)450-3680		(800)450-3680		(800)450-3680		(800)450-3680		(800)450-3680		(800)450-3680		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;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;10a;15;	2		1				
H5900	001	0	1	04	01	H5900_001_0	7	1					1	08/05/2022	2023.01	08/05/2022 06:21:32 PM Eastern Daylight Time	08/05/2022 06:05:08 PM Eastern Daylight Time	08/05/2022 06:42:49 PM Eastern Daylight Time			08/05/2022 06:49:14 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage PPO (PPO)	01	04		1			H5900	001	0	2023	Iowa		2		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					1	08/05/2022	2023.01	08/05/2022 06:22:57 PM Eastern Daylight Time	08/05/2022 06:05:08 PM Eastern Daylight Time	08/05/2022 06:42:49 PM Eastern Daylight Time			08/05/2022 06:49:14 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Enhanced PPO (PPO)	01	04		1			H5900	002	0	2023	Iowa		2		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	7	1					1	08/05/2022	2023.01	08/05/2022 06:26:19 PM Eastern Daylight Time	08/05/2022 06:05:08 PM Eastern Daylight Time	08/05/2022 06:42:49 PM Eastern Daylight Time			08/05/2022 06:49:14 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage PPO (PPO)	01	04		1			H5900	003	0	2023	South Dakota		2		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	8	1					1	08/05/2022	2023.01	08/05/2022 06:27:56 PM Eastern Daylight Time	08/05/2022 06:05:09 PM Eastern Daylight Time	08/05/2022 06:42:49 PM Eastern Daylight Time			08/05/2022 06:49:14 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Enhanced PPO (PPO)	01	04		1			H5900	004	0	2023	South Dakota		2		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	005	0	1	04	01	H5900_005_0	7	1					1	07/08/2022	2023.01	07/08/2022 04:00:45 PM Eastern Daylight Time	08/05/2022 06:05:09 PM Eastern Daylight Time	08/05/2022 06:42:49 PM Eastern Daylight Time			08/05/2022 06:49:14 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage PPO | Avera (PPO)	01	04		1			H5900	005	0	2023	South Dakota		2		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						1	01	3-1;3-2;3-4;7a;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;8a1;8a2;8b1;8b3;9a1;9b;9c;11a;11b1;11b2;11c1;11c2;16b;17a;18a;	
H5900	006	0	1	04	01	H5900_006_0	5	1				0	0	07/08/2022	2023.01	07/08/2022 04:01:52 PM Eastern Daylight Time	06/06/2022 10:29:40 AM Eastern Daylight Time				07/08/2022 05:01:51 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Valor PPO (PPO)	01	04		1			H5900	006	0	2023	Iowa		2		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)-										2					2						2			
H5900	007	0	1	04	01	H5900_007_0	5	1				0	0	07/08/2022	2023.01	07/08/2022 04:06:31 PM Eastern Daylight Time	06/06/2022 10:29:40 AM Eastern Daylight Time				07/08/2022 05:01:51 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Valor PPO (PPO)	01	04		1			H5900	007	0	2023	South Dakota		2		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)-										2					2						2			
H5900	801	0	1	04	01	H5900_801_0	4	1						05/02/2022	2023.01	05/02/2022 11:01:12 AM Eastern Daylight Time					06/06/2022 07:13:11 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Group PPO (PPO)	01	04		1			H5900	801	0	2023	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	4	1				0	0	05/02/2022	2023.01	05/02/2022 11:03:10 AM Eastern Daylight Time					06/06/2022 07:13:11 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Group PPO (PPO)	01	04		1			H5900	802	0	2023	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	1	1						05/26/2022	2023.01	05/26/2022 10:33:07 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Altoona / Ebensburg / Indiana	www.seniorlifepa.com	Senior LIFE Altoona Dual Eligible (PACE)	08	20		1			H5902	001	0	2023	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	1	1						05/26/2022	2023.01	05/26/2022 10:33:13 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Altoona / Ebensburg / Indiana	www.seniorlifepa.com	Senior LIFE Altoona Medicare Only (PACE)	08	20		1			H5902	002	0	2023	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	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:34:53 PM Pacific Daylight Time	08/04/2022 06:07:46 PM Pacific Daylight Time	08/01/2022 10:41:32 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	9	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:35:09 PM Pacific Daylight Time	08/04/2022 06:08:14 PM Pacific Daylight Time	08/01/2022 10:42:06 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 05:35:35 PM Pacific Daylight Time	08/04/2022 06:08:46 PM Pacific Daylight Time	08/01/2022 10:42:40 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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			
H5926	007	0	1	01	01	H5926_007_0	7	1					1	08/04/2022	2023.01	08/04/2022 02:20:46 PM Pacific Daylight Time	08/04/2022 06:09:14 PM Pacific Daylight Time	08/01/2022 03:31:36 PM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/medicare	Molina Medicare Choice Care Select (HMO)	01	01		1			H5926	007	0	2023	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	6	1						08/04/2022	2023.01	08/04/2022 02:29:26 PM Pacific Daylight Time	08/03/2022 04:43:53 PM Pacific Daylight Time	08/02/2022 04:37:06 PM Pacific Daylight Time			08/05/2022 08:48:24 AM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield AdvantageOptimum Plan (HMO)	01	01		1			H5928	004	0	2023	Los Angeles and Orange Counties		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	4	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:32:46 PM Pacific Daylight Time	08/03/2022 07:57:00 PM Pacific Daylight Time	08/02/2022 04:38:59 PM Pacific Daylight Time			08/05/2022 08:48:24 AM 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	2023	Los Angeles and San Diego Counties		2		2			1	3		2					1	blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	blueshieldca.com/find-a-doctor	(800)452-4413		(800)452-4413		(888)534-4263		(888)534-4263		(800)452-4413		(800)452-4413		(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	5	1						08/04/2022	2023.01	08/04/2022 02:30:31 PM Pacific Daylight Time	08/03/2022 04:45:01 PM Pacific Daylight Time	08/02/2022 04:47:23 PM Pacific Daylight Time			08/05/2022 08:48:24 AM 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	2023	San Diego County		2		2			2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	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	5	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:36:42 PM Pacific Daylight Time	08/03/2022 04:45:26 PM Pacific Daylight Time	08/02/2022 04:42:04 PM Pacific Daylight Time			08/05/2022 08:48:24 AM 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	2023	Counties: FR, SJ, STAN, MER		2		2			1	3		2					1	blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	blueshieldca.com/find-a-doctor	(800)452-4413		(800)452-4413		(888)534-4263		(888)534-4263		(800)452-4413		(800)452-4413		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	055	0	1	01	01	H5928_055_0	4	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:38:23 PM Pacific Daylight Time	08/03/2022 04:44:18 PM Pacific Daylight Time	08/02/2022 04:46:28 PM Pacific Daylight Time			08/05/2022 08:48:24 AM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield TotalDual Plan (HMO D-SNP)	01	01		1			H5928	055	0	2023	Orange and San Bernardino Counties		2		2			1	3		2					1	blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023	blueshieldca.com/find-a-doctor	(800)452-4413		(800)452-4413		(888)534-4263		(888)534-4263		(800)452-4413		(800)452-4413		(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	11	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 09:42:43 AM Eastern Daylight Time	08/04/2022 01:32:52 PM Eastern Daylight Time	08/01/2022 08:19:16 AM Eastern Daylight Time			08/05/2022 11:36:23 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Highmark Wholecare Medicare Assured	www.highmarkwholecare.com	Highmark Wholecare Medicare Assured Diamond (HMO D-SNP)	01	01		1			H5932	001	0	2023	SW NW NE Central Pennsylvania Counties		2		2			1	3		1					1	www.highmarkwholecare.com	www.highmarkwholecare.com	www.highmarkwholecare.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	9	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 09:43:38 AM Eastern Daylight Time	08/04/2022 01:49:46 PM Eastern Daylight Time	08/01/2022 08:20:54 AM Eastern Daylight Time			08/05/2022 11:36:23 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Highmark Wholecare Medicare Assured	www.highmarkwholecare.com	Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)	01	01		1			H5932	009	0	2023	SW NW NE Central Pennsylvania Counties		2		2			1	3		2					2	www.highmarkwholecare.com	www.highmarkwholecare.com	www.highmarkwholecare.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	11	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 09:43:06 AM Eastern Daylight Time	08/04/2022 01:45:56 PM Eastern Daylight Time	08/01/2022 08:22:32 AM Eastern Daylight Time			08/05/2022 11:36:23 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Highmark Wholecare Medicare Assured	www.highmarkwholecare.com	Highmark Wholecare Medicare Assured Diamond (HMO D-SNP)	01	01		1			H5932	012	0	2023	SE Pennsylvania Counties		2		2			1	3		1					1	www.highmarkwholecare.com	www.highmarkwholecare.com	www.highmarkwholecare.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	9	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 09:44:51 AM Eastern Daylight Time	08/04/2022 01:48:20 PM Eastern Daylight Time	08/01/2022 08:24:10 AM Eastern Daylight Time			08/05/2022 11:36:23 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Highmark Wholecare Medicare Assured	www.highmarkwholecare.com	Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)	01	01		1			H5932	013	0	2023	SE Pennsylvania Counties		2		2			1	3		2					2	www.highmarkwholecare.com	www.highmarkwholecare.com	www.highmarkwholecare.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						06/01/2022	2023.01	06/01/2022 01:18:27 PM Eastern Daylight Time		06/01/2022 12:51:11 PM Eastern Daylight Time			06/01/2022 01:20:56 PM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	www.hopepace.org	Hope PACE (PACE)	08	20		1			H5934	001	0	2023	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						06/01/2022	2023.01	06/01/2022 01:19:00 PM Eastern Daylight Time		06/01/2022 12:51:11 PM Eastern Daylight Time			06/01/2022 01:20:56 PM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	www.hopepace.org	Hope PACE (PACE)	08	20		1			H5934	002	0	2023	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	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 07:08:11 AM Central Daylight Time	08/04/2022 01:35:40 PM Central Daylight Time	08/01/2022 07:16:08 PM Central Daylight Time			08/04/2022 05:33:09 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Connect + Medicare (HMO D-SNP)	01	01		1			H5937	001	0	2023	65 Counties		2		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)676-6652		(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			
H5938	001	0	1	01	01	H5938_001_0	10	1					1	07/05/2022	2023.01	07/05/2022 09:57:04 AM Eastern Daylight Time	08/05/2022 08:57:14 AM Eastern Daylight Time	08/05/2022 08:57:14 AM Eastern Daylight Time			08/05/2022 01:41:00 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	2023	Leon and surrounding counties		2		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	10	1					1	07/05/2022	2023.01	07/05/2022 10:03:08 AM Eastern Daylight Time	08/05/2022 08:57:15 AM Eastern Daylight Time	08/05/2022 08:57:15 AM Eastern Daylight Time			08/05/2022 01:37:50 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	2023	Leon and surrounding counties		2		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	10	1					1	07/05/2022	2023.01	07/05/2022 10:08:52 AM Eastern Daylight Time	08/05/2022 08:57:15 AM Eastern Daylight Time	08/05/2022 08:57:15 AM Eastern Daylight Time			08/05/2022 01:33:21 PM 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	2023	Leon and surrounding counties		2		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	6	1						05/25/2022	2023.01	05/25/2022 05:02:58 PM Eastern Daylight Time					06/06/2022 03:33:56 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	802	0	2023	Leon and surrounding counties		1	115733	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;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	803	0	1	01	01	H5938_803_0	6	1				0	0	05/25/2022	2023.01	05/25/2022 05:04:52 PM Eastern Daylight Time					06/06/2022 03:33:56 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	803	0	2023	Leon and surrounding counties		1	13633	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;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	6	1						05/25/2022	2023.01	05/25/2022 05:07:23 PM Eastern Daylight Time					06/06/2022 03:33:56 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	804	0	2023	Leon and surrounding counties		1	20599	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;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	6	1						05/25/2022	2023.01	05/25/2022 05:09:00 PM Eastern Daylight Time					06/06/2022 03:33:56 PM 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	2023	Florida Statewide		1	13633	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;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	9	1		1				06/03/2022	2023.01	06/03/2022 02:15:38 PM Pacific Daylight Time		08/02/2022 10:08:31 PM Pacific Daylight Time		08/04/2022 08:49:57 AM Pacific Daylight Time	08/19/2022 07:59:55 AM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS C-SNP)	01	02		1			H5943	001	0	2023	Riverside and  San Bernardino Counties		2		2			1	4			00000000100000000000000					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	8	1		1				06/03/2022	2023.01	06/03/2022 02:17:03 PM Pacific Daylight Time		08/02/2022 10:08:46 PM Pacific Daylight Time		08/04/2022 08:51:02 AM Pacific Daylight Time	08/19/2022 07:59:55 AM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS C-SNP)	01	02		1			H5943	002	0	2023	Los Angeles County		2		2			1	4			00000000100000000000000					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	5	1			2		1	08/03/2022	2023.01	08/03/2022 12:00:57 PM Pacific Daylight Time	08/03/2022 03:45:26 PM Pacific Daylight Time	08/03/2022 03:45:26 PM Pacific Daylight Time			08/03/2022 03:57:19 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H5945	001	0	2023	Carson City, Douglas, Lyon, Storey, Churchill		2		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	5	1			2		1	08/03/2022	2023.01	08/03/2022 12:01:31 PM Pacific Daylight Time	08/03/2022 03:45:27 PM Pacific Daylight Time	08/03/2022 03:45:27 PM Pacific Daylight Time			08/03/2022 03:57:19 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H5945	002	0	2023	Washoe County		2		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	6	1			2		1	08/03/2022	2023.01	08/03/2022 12:01:53 PM Pacific Daylight Time	08/03/2022 03:45:24 PM Pacific Daylight Time	08/03/2022 03:45:24 PM Pacific Daylight Time			08/03/2022 03:57:19 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H5945	008	0	2023	Palm Beach		2		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	4	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 01:18:13 PM Pacific Daylight Time	08/03/2022 03:45:24 PM Pacific Daylight Time	08/03/2022 03:45:24 PM Pacific Daylight Time			08/03/2022 03:57:19 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Dual (HMO D-SNP)	01	01		1			H5945	009	0	2023	Palm Beach County		2		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	1	1				0	0	05/19/2022	2023.01	05/19/2022 10:36:43 AM Pacific Daylight Time					06/02/2022 11:44:26 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	801	0	2023	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	1	1						05/19/2022	2023.01	05/19/2022 10:30:12 AM Pacific Daylight Time					06/02/2022 11:44:26 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	802	0	2023	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	05/06/2022	2023.01	05/06/2022 02:09:14 PM Pacific Daylight Time					06/02/2022 11:44:26 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	804	0	2023	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						05/06/2022	2023.01	05/06/2022 02:57:34 PM Pacific Daylight Time					06/02/2022 11:44:26 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	805	0	2023	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)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5959	007	1	1	04	01	H5959_007_1	4	1				0	0	07/11/2022	2023.01	07/11/2022 11:18:46 AM Central Daylight Time	06/05/2022 05:59:04 PM Central Daylight Time				07/11/2022 03:54:38 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Freedom Blue (PPO)	01	04		1			H5959	007	1	2023	51 County Region	Eleven County Region	2		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	6	1				0	0	07/11/2022	2023.01	07/11/2022 11:34:24 AM Central Daylight Time	06/05/2022 05:59:56 PM Central Daylight Time				07/11/2022 03:54:38 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Freedom Blue (PPO)	01	04		1			H5959	007	2	2023	51 County Region	40 County Region	2		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	3	1				0	0	07/11/2022	2023.01	07/11/2022 11:44:54 AM Central Daylight Time	06/03/2022 12:55:50 PM Central Daylight Time				07/11/2022 03:54:38 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Freedom Blue (PPO)	01	04		1			H5959	008	0	2023	15 County Region		2		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	5	1						07/11/2022	2023.01	07/11/2022 11:49:17 AM Central Daylight Time	08/02/2022 05:13:25 PM Central Daylight Time	07/31/2022 01:29:48 PM Central Daylight Time			08/03/2022 02:08:25 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice (PPO)	01	04		1			H5959	009	0	2023	15 County Region		2		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		(651)662-5513		(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	6	1					1	07/11/2022	2023.01	07/11/2022 11:52:53 AM Central Daylight Time	08/02/2022 05:14:56 PM Central Daylight Time	07/31/2022 01:31:48 PM Central Daylight Time			08/03/2022 02:51:24 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Complete (PPO)	01	04		1			H5959	010	1	2023	51 County Region	Eleven County Region	2		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		(651)662-5513		(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	6	1					1	07/11/2022	2023.01	07/11/2022 12:08:46 PM Central Daylight Time	08/02/2022 05:16:23 PM Central Daylight Time	07/31/2022 01:33:50 PM Central Daylight Time			08/03/2022 02:51:24 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Complete (PPO)	01	04		1			H5959	010	2	2023	51 County Region	40 County Region	2		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		(651)662-5513		(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	10	1					1	07/11/2022	2023.01	07/11/2022 12:25:35 PM Central Daylight Time	08/02/2022 05:17:48 PM Central Daylight Time	07/31/2022 01:35:50 PM Central Daylight Time			08/03/2022 02:51:24 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Complete (PPO)	01	04		1			H5959	011	0	2023	15 County Region		2		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		(651)662-5513		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	012	0	1	04	01	H5959_012_0	7	1						07/11/2022	2023.01	07/11/2022 12:34:16 PM Central Daylight Time	08/02/2022 05:19:26 PM Central Daylight Time	07/31/2022 01:37:50 PM Central Daylight Time			08/03/2022 02:25:03 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Core (PPO)	01	04		1			H5959	012	0	2023	15 County Region		2		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		(651)662-5513		(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	6	1					0	08/03/2022	2023.01	08/03/2022 01:45:47 PM Central Daylight Time	08/02/2022 05:20:53 PM Central Daylight Time	07/31/2022 01:39:50 PM Central Daylight Time			08/03/2022 02:25:03 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Core (PPO)	01	04		1			H5959	013	1	2023	51 County Region	Eleven County Region	2		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		(651)662-5513		(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	8	1					0	08/03/2022	2023.01	08/03/2022 01:48:42 PM Central Daylight Time	08/02/2022 05:22:27 PM Central Daylight Time	07/31/2022 01:41:52 PM Central Daylight Time			08/03/2022 02:25:03 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Core (PPO)	01	04		1			H5959	013	2	2023	51 County Region	40 County Region	2		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		(651)662-5513		(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	8	1					0	07/11/2022	2023.01	07/11/2022 12:59:31 PM Central Daylight Time	08/02/2022 05:24:04 PM Central Daylight Time	07/31/2022 01:43:52 PM Central Daylight Time			08/03/2022 02:08:25 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice (PPO)	01	04		1			H5959	014	1	2023	51 County Region	Eleven County Region	2		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		(651)662-5513		(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	6	1					0	07/11/2022	2023.01	07/11/2022 01:03:24 PM Central Daylight Time	08/02/2022 05:25:28 PM Central Daylight Time	07/31/2022 01:45:52 PM Central Daylight Time			08/03/2022 02:08:25 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice (PPO)	01	04		1			H5959	014	2	2023	51 County Region	40 County Region	2		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		(651)662-5513		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	015	0	1	04	01	H5959_015_0	7	1					0	07/11/2022	2023.01	07/11/2022 01:08:04 PM Central Daylight Time	08/02/2022 05:26:58 PM Central Daylight Time	07/31/2022 01:47:50 PM Central Daylight Time			08/03/2022 03:12:09 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Comfort (PPO)	01	04		1			H5959	015	0	2023	Eleven County Region		2		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		(651)662-5513		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	016	0	1	04	01	H5959_016_0	6	1					0	07/11/2022	2023.01	07/11/2022 01:24:41 PM Central Daylight Time	08/02/2022 05:28:29 PM Central Daylight Time	07/31/2022 01:49:48 PM Central Daylight Time			08/03/2022 03:12:09 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Comfort (PPO)	01	04		1			H5959	016	0	2023	40 County Region		2		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		(651)662-5513		(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						05/24/2022	2023.01	05/24/2022 07:24:49 AM Central Daylight Time					06/01/2022 07:37:47 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Group EGWP MAPD (PPO)	01	04		1			H5959	801	0	2023	National		1	327	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		(651)662-5513		(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	05/24/2022	2023.01	05/24/2022 07:26:14 AM Central Daylight Time					06/01/2022 07:37:47 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Group EGWP Medical Only (PPO)	01	04		1			H5959	807	0	2023	National		1	56346	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	808	0	1	04	01	H5959_808_0	1	1						05/24/2022	2023.01	05/24/2022 07:27:47 AM Central Daylight Time					06/01/2022 07:37:47 PM Central Daylight Time	BCBSM, Inc.	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Group EGWP MAPD (PPO)	01	04		1			H5959	808	0	2023	National		1	327	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		(651)662-5513		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5965	002	0	1	04	01	H5965_002_0	4	1						08/02/2022	2023.01	08/02/2022 10:22:27 AM Eastern Daylight Time	08/03/2022 08:28:34 PM Eastern Daylight Time	07/30/2022 09:53:01 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in WA		2		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	05/29/2022	2023.01	05/29/2022 05:08:22 PM Eastern Daylight Time	06/03/2022 09:04:13 PM Central Daylight Time				07/15/2022 04:24:29 PM Central Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback Open (PPO)	01	04		1			H5965	003	0	2023	Select counties in WA		2		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	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:03:04 PM Eastern Daylight Time	08/03/2022 08:29:58 PM Eastern Daylight Time	07/30/2022 09:53:33 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in WA		2		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	1		0	08/05/2022	2023.01	08/05/2022 04:31:30 PM Pacific Daylight Time	08/05/2022 03:42:08 PM Pacific Daylight Time	07/29/2022 02:48:52 PM Pacific Daylight Time			08/05/2022 04:32:00 PM Pacific Daylight Time	ALOHACARE	AlohaCare	AlohaCare.org	AlohaCare Advantage Plus (HMO D-SNP)	01	01		1			H5969	002	0	2023	State of Hawaii		2		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	2	1			1		1	05/30/2022	2023.01	05/30/2022 12:22:45 PM Eastern Daylight Time	08/03/2022 03:37:19 PM Eastern Daylight Time	07/30/2022 09:17:50 AM Eastern Daylight Time			08/04/2022 03:11:04 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	2023	Select Counties in New York		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:18:08 PM Eastern Daylight Time	08/03/2022 03:41:28 PM Eastern Daylight Time	07/30/2022 09:18:14 AM Eastern Daylight Time			08/04/2022 03:11:04 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	2023	Select Counties in New York		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1	1			2	0	0	05/28/2022	2023.01	05/28/2022 10:37:14 AM Eastern Daylight Time	06/01/2022 11:08:33 AM Eastern Daylight Time				06/02/2022 09:21:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5970	016	0	2023	Select Counties in New York		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5970	018	0	1	04	01	H5970_018_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:20:23 PM Eastern Daylight Time	08/03/2022 03:41:59 PM Eastern Daylight Time	07/30/2022 09:18:40 AM Eastern Daylight Time			08/04/2022 03:16:11 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	2023	Select Counties in New York		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	2	1	1		0	05/28/2022	2023.01	05/28/2022 10:24:29 AM Eastern Daylight Time	08/03/2022 03:45:38 PM Eastern Daylight Time	07/30/2022 09:19:06 AM Eastern Daylight Time			08/04/2022 03:02:51 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	2023	Cattaraugus, Chautauqua and Madison counties		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 01:22:25 PM Eastern Daylight Time	08/03/2022 03:48:45 PM Eastern Daylight Time	07/30/2022 09:19:32 AM Eastern Daylight Time			08/04/2022 03:16:11 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	2023	New York City and Long Island	Select Counties in New York City	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	08/01/2022	2023.01	08/01/2022 01:24:25 PM Eastern Daylight Time	08/03/2022 03:49:16 PM Eastern Daylight Time	07/30/2022 09:19:56 AM Eastern Daylight Time			08/04/2022 03:16:11 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	2023	New York City and Long Island	Nassau, Richmond and Suffolk counties	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			2		1	05/28/2022	2023.01	05/28/2022 10:42:30 AM Eastern Daylight Time	08/03/2022 03:52:56 PM Eastern Daylight Time	07/30/2022 09:20:22 AM Eastern Daylight Time			08/04/2022 03:16:11 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	2023	Select Counties in New York		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)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	7a;7g;8a1;8b3;	
H5970	026	0	1	04	01	H5970_026_0	2	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 10:58:28 AM Eastern Daylight Time	08/03/2022 03:51:22 PM Eastern Daylight Time	07/30/2022 09:20:48 AM Eastern Daylight Time			08/04/2022 03:16:11 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	2023	Bronx		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	027	0	1	04	01	H5970_027_0	2	1			2		1	08/01/2022	2023.01	08/01/2022 01:26:26 PM Eastern Daylight Time	08/03/2022 03:55:36 PM Eastern Daylight Time	07/30/2022 09:21:14 AM Eastern Daylight Time			08/04/2022 03:16:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice Partnered H5970-027 (PPO)	01	04		1			H5970	027	0	2023	Select Counties in New York		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)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	7a;7g;8a1;8b3;	
H5970	801	0	1	04	01	H5970_801_0	6	1						05/27/2022	2023.01	05/27/2022 12:20:28 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	118933	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:20:46 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	7911	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:21:06 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:21:24 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:21:50 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	817	0	1	04	01	H5970_817_0	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:22:11 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	818	0	1	04	01	H5970_818_0	6	1						05/27/2022	2023.01	05/27/2022 12:22:31 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	819	0	1	04	01	H5970_819_0	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:22:49 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	820	0	1	04	01	H5970_820_0	6	1						05/27/2022	2023.01	05/27/2022 12:23:11 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	821	0	1	04	01	H5970_821_0	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:23:34 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	822	0	1	04	01	H5970_822_0	6	1						05/27/2022	2023.01	05/27/2022 12:23:54 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	823	0	1	04	01	H5970_823_0	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:24:18 PM Eastern Daylight Time					06/02/2022 05:55:36 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	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	824	0	1	04	01	H5970_824_0	4	1						05/31/2022	2023.01	05/31/2022 10:15:00 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	824	0	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	825	0	1	04	01	H5970_825_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 10:17:18 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	825	0	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	826	0	1	04	01	H5970_826_0	4	1						05/31/2022	2023.01	05/31/2022 10:20:53 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	826	0	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	827	0	1	04	01	H5970_827_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 10:23:10 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	827	0	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	828	0	1	04	01	H5970_828_0	4	1						05/31/2022	2023.01	05/31/2022 10:25:24 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	828	0	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	829	0	1	04	01	H5970_829_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 10:27:35 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	829	0	2023	State of New York		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/26/2022	2023.01	05/26/2022 10:33:21 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM Eastern Daylight Time	SENIOR LIFE LEHIGH VALLEY, INC.	Senior LIFE Lehigh Valley / Reading	www.seniorlifepa.com	Senior LIFE Lehigh Valley Dual Eligible (PACE)	08	20		1			H5978	001	0	2023	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	1	1						05/26/2022	2023.01	05/26/2022 10:33:28 AM Eastern Daylight Time		05/26/2022 09:32:00 AM Eastern Daylight Time			05/26/2022 10:39:30 AM Eastern Daylight Time	SENIOR LIFE LEHIGH VALLEY, INC.	Senior LIFE Lehigh Valley / Reading	www.seniorlifepa.com	Senior LIFE Lehigh Valley Medicare Only (PACE)	08	20		1			H5978	002	0	2023	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	8	1					1	08/05/2022	2023.01	08/05/2022 01:09:33 PM Eastern Daylight Time	08/04/2022 08:47:10 PM Eastern Daylight Time	08/04/2022 05:37:32 PM Eastern Daylight Time			08/05/2022 02:49:29 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Signature (HMO)	01	01		1			H5989	011	0	2023	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	010	0	1	01	01	H5991_010_0	11	1	2	1	1		0	07/22/2022	2023.01	07/22/2022 12:53:15 PM Eastern Daylight Time	08/05/2022 12:03:32 PM Eastern Daylight Time	08/05/2022 12:02:20 PM Eastern Daylight Time			08/05/2022 12:59:26 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	2023	Bronx, Kings, New York, Queens		2		2			1	3		1					1	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(877)344-7364		(877)344-7364		(800)447-2254		(800)447-2254		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5992	007	0	1	01	01	H5992_007_0	11	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:36:02 PM Pacific Daylight Time	08/04/2022 06:09:42 PM Pacific Daylight Time	08/01/2022 10:43:48 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Senior Whole Health of New York	www.molinahealthcare.com/medicare	Senior Whole Health of New York NHC (HMO D-SNP)	01	01		1			H5992	007	0	2023	Counties: Ki, Qu, Brx, NY, Wes, and Na		2		2			1	3		1					1	www.seniorwholehealth.com	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(833)671-0440		(833)671-0440		(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	9	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:22:27 PM Pacific Daylight Time	08/04/2022 06:10:12 PM Pacific Daylight Time	08/01/2022 10:44:22 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Senior Whole Health of New York	www.molinahealthcare.com/medicare	Senior Whole Health Medicare Complete Care (HMO D-SNP)	01	01		1			H5992	008	0	2023	Select Counties in New York		2		2			1	3		1					1	www.seniorwholehealth.com	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(877)353-0185		(877)353-0185		(833)671-0444		(833)671-0444		(877)353-0185		(877)353-0185		(833)671-0444		(833)671-0444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5995	001	0	1	01	01	H5995_001_0	5	1	2	1			0	08/04/2022	2023.01	08/04/2022 10:10:53 AM Pacific Daylight Time	08/03/2022 02:40:34 PM Pacific Daylight Time	08/01/2022 10:53:14 AM Pacific Daylight Time			08/04/2022 06:59:43 PM 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	2023	Marion and Polk 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			
H6018	001	0	1	04	01	H6018_001_0	9	1					1	08/04/2022	2023.01	08/04/2022 11:23:03 PM US Eastern Daylight Time	08/04/2022 09:49:22 AM Eastern Daylight Time	07/31/2022 01:51:43 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA I	Devoted Health	www.Devoted.com	Devoted CHOICE Pennsylvania (PPO)	01	04		1			H6018	001	0	2023	Bucks, Chester, Delaware, Montgomery, Philadelphia		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			
H6019	001	0	1	01	01	H6019_001_0	5	1	2	1			0	08/09/2022	2023.01	08/09/2022 01:22:40 PM Pacific Daylight Time	08/03/2022 06:39:43 PM Pacific Daylight Time	08/03/2022 08:27:03 AM Pacific Daylight Time			08/10/2022 12:59:36 PM Pacific Daylight Time	SAN MATEO HEALTH COMMISSION	HEALTH PLAN OF SAN MATEO	www.hpsm.org	CareAdvantage (HMO D-SNP)	01	01		1			H6019	001	0	2023	San Mateo County		2		2			1	3		1					1	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		2					2					2	2			
H6059	001	0	1	20	08	H6059_001_0	1	1						06/01/2022	2023.01	06/01/2022 01:08:10 PM Eastern Daylight Time		05/27/2022 01:09:04 PM Eastern Daylight Time			06/01/2022 01:11:14 PM Eastern Daylight Time	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	PACE OF THE TRIAD	www.pacetriad.org	PACE of The Triad - Dual (PACE)	08	20		1			H6059	001	0	2023	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						06/01/2022	2023.01	06/01/2022 01:08:20 PM Eastern Daylight Time		05/27/2022 01:09:04 PM Eastern Daylight Time			06/01/2022 01:11:14 PM Eastern Daylight Time	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	PACE OF THE TRIAD	www.pacetriad.org	PACE of The Triad - Medicare only (PACE)	08	20		1			H6059	002	0	2023	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			2		0	07/13/2022	2023.01	07/13/2022 07:22:49 AM Central Daylight Time	08/04/2022 09:12:10 AM Central Daylight Time	08/01/2022 10:32:30 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/Texas/medicare	Texas LoneStar Gold (HMO)	01	01		1			H6062	001	0	2023	Dallas Metro		2		2			2									www.GlobalHealth.com/Texas/pharmacy-directories	www.globalhealth.com/Texas/pharmacy/drug-formularies	www.GlobalHealth.com/Texas/provider-search	(844)200-8167		(972)426-7955		(844)498-1164		(405)280-5874		(844)449-0360		(844)449-0360		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6062	003	0	1	01	01	H6062_003_0	7	1			2		0	07/13/2022	2023.01	07/13/2022 06:52:18 AM Central Daylight Time	08/04/2022 09:12:54 AM Central Daylight Time	08/01/2022 10:33:04 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/Texas/medicare	Texas LoneStar Gold (HMO)	01	01		1			H6062	003	0	2023	Houston Metro		2		2			2									www.GlobalHealth.com/Texas/pharmacy-directories	www.globalhealth.com/Texas/pharmacy/drug-formularies	www.GlobalHealth.com/Texas/provider-search	(844)200-8167		(972)426-7955		(844)498-1164		(405)280-5874		(844)449-0360		(844)449-0360		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6062	005	0	1	01	01	H6062_005_0	8	1		1	2		1	07/13/2022	2023.01	07/13/2022 07:25:52 AM Central Daylight Time	08/04/2022 09:13:36 AM Central Daylight Time	08/01/2022 10:33:34 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/Texas/medicare	Texas LoneStar Chronic Care (HMO C-SNP)	01	01		1			H6062	005	0	2023	Dallas/Fort Worth		2		2			1	4			00000000000000000010000					www.GlobalHealth.com/Texas/pharmacy-directories	www.globalhealth.com/Texas/pharmacy/drug-formularies	www.GlobalHealth.com/Texas/provider-search	(844)200-8167		(972)426-7955		(844)498-1164		(405)280-5874		(844)449-0360		(844)449-0360		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6062	006	0	1	01	01	H6062_006_0	8	1		1	2		1	07/13/2022	2023.01	07/13/2022 07:26:39 AM Central Daylight Time	08/04/2022 09:14:20 AM Central Daylight Time	08/01/2022 10:34:06 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/Texas/medicare	Texas LoneStar Chronic Care Savings (HMO C-SNP)	01	01		1			H6062	006	0	2023	Dallas/Ft  Worth		2		2			1	4			00000000000000000010000					www.GlobalHealth.com/Texas/pharmacy-directories	www.globalhealth.com/Texas/pharmacy/drug-formularies	www.GlobalHealth.com/Texas/provider-search	(844)200-8167		(972)426-7955		(844)498-1164		(405)280-5874		(844)449-0360		(844)449-0360		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6062	009	0	1	01	01	H6062_009_0	8	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 07:27:23 AM Central Daylight Time	08/04/2022 09:15:06 AM Central Daylight Time	08/01/2022 10:34:38 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/Texas/medicare	Texas LoneStar Dual Support (HMO D-SNP)	01	01		1			H6062	009	0	2023	Dallas Metro		2		2			1	3		2					2	www.GlobalHealth.com/Texas/pharmacy-directories	www.globalhealth.com/Texas/pharmacy/drug-formularies	www.GlobalHealth.com/Texas/provider-search	(844)200-8167		(972)426-7955		(844)498-1164		(405)280-5874		(844)449-0360		(844)449-0360		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6062	010	0	1	01	01	H6062_010_0	8	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 07:28:15 AM Central Daylight Time	08/04/2022 09:15:48 AM Central Daylight Time	08/01/2022 10:35:10 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/Texas/medicare	Texas LoneStar Dual Premier (HMO D-SNP)	01	01		1			H6062	010	0	2023	Dallas Metro		2		2			1	3		1					1	www.GlobalHealth.com/Texas/pharmacy-directories	www.globalhealth.com/Texas/pharmacy/drug-formularies	www.GlobalHealth.com/Texas/provider-search	(844)200-8167		(972)426-7955		(844)498-1164		(405)280-5874		(844)449-0360		(844)449-0360		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6062	011	0	1	01	01	H6062_011_0	7	1			2		0	07/13/2022	2023.01	07/13/2022 07:29:18 AM Central Daylight Time	08/04/2022 09:16:28 AM Central Daylight Time	08/01/2022 10:35:42 AM Central Daylight Time			08/04/2022 04:53:42 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/Texas/medicare	Texas LoneStar Gold Rewards (HMO)	01	01		1			H6062	011	0	2023	Dallas Metro		2		2			2									www.GlobalHealth.com/Texas/pharmacy-directories	www.GlobalHealth.com/Texas/pharmacy/drug-formularies	www.GlobalHealth.com/Texas/provider-search	(844)200-8167		(972)426-7955		(844)498-1164		(405)280-5874		(844)449-0360		(844)449-0360		(844)498-1164		(405)280-5874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6062	012	0	1	02	01	H6062_012_0	6	1			2	0	0	07/13/2022	2023.01	07/13/2022 07:29:48 AM Central Daylight Time	07/13/2022 04:08:06 PM Central Daylight Time				07/18/2022 07:47:45 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/Texas/medicare	Texas LoneStar Valor (HMO-POS)	01	02		1			H6062	012	0	2023	Dallas Metro		2		2			2									www.GlobalHealth.com/Texas/pharmacy-directories	www.GlobalHealth/com/Texas/pharmacy/drug-formularies	www.GlobalHealth.com/Texas/provider-search	(844)200-8167		(972)426-7955		(844)498-1164		(405)280-5874										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6067	001	1	1	01	01	H6067_001_1	9	1					1	08/01/2022	2023.01	08/01/2022 09:46:16 AM Eastern Daylight Time	08/05/2022 02:42:40 PM Eastern Daylight Time	08/05/2022 02:42:40 PM Eastern Daylight Time			08/05/2022 02:45:36 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	2023	Central Maryland	Counties: AA, CA, FR, HA, HO	2		2			2									carefirst.com/medicareadvantage	carefirst.com/medicareadvantage	https://carefirst.sapphirecareselect.com/?ci=dft-carefirstbcbsmedicareadvantagehmo	(855)290-5744		(855)290-5744		(888)532-0311		(888)532-0311		(888)970-0917		(888)970-0917		(888)532-1183		(888)532-1183		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6067	001	2	1	01	01	H6067_001_2	10	1					1	07/05/2022	2023.01	07/05/2022 10:44:04 AM Eastern Daylight Time	08/05/2022 02:42:40 PM Eastern Daylight Time	08/05/2022 02:42:40 PM Eastern Daylight Time			08/05/2022 02:45:36 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	2023	Central Maryland	Counties: BA, BC, MO, PG	2		2			2									carefirst.com/medicareadvantage	carefirst.com/medicareadvantage	https://carefirst.sapphirecareselect.com/?ci=dft-carefirstbcbsmedicareadvantagehmo	(855)290-5744		(855)290-5744		(888)532-0311		(888)532-0311		(888)970-0917		(888)970-0917		(888)532-1183		(888)532-1183		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6067	002	1	1	01	01	H6067_002_1	10	1					1	08/10/2022	2023.01	08/10/2022 03:53:00 PM Eastern Daylight Time	08/11/2022 09:49:13 AM Eastern Daylight Time	08/05/2022 04:04:08 PM Eastern Daylight Time			08/11/2022 09:50:14 AM 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	2023	Central Maryland	Counties: AA, CA, FR, HA, HO	2		2			2									carefirst.com/medicareadvantage	carefirst.com/medicareadvantage	https://carefirst.sapphirecareselect.com/?ci=dft-carefirstbcbsmedicareadvantagehmo	(855)290-5744		(855)290-5744		(888)532-0311		(888)532-0311		(888)970-0917		(888)970-0917		(888)532-1183		(888)532-1183		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6067	002	2	1	01	01	H6067_002_2	11	1					1	08/10/2022	2023.01	08/10/2022 03:53:14 PM Eastern Daylight Time	08/11/2022 09:49:07 AM Eastern Daylight Time	08/05/2022 04:04:08 PM Eastern Daylight Time			08/11/2022 09:50:14 AM 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	2023	Central Maryland	Counties: BA, BC, MO, PG	2		2			2									carefirst.com/medicareadvantage	carefirst.com/medicareadvantage	https://carefirst.sapphirecareselect.com/?ci=dft-carefirstbcbsmedicareadvantagehmo	(855)290-5744		(855)290-5744		(888)532-0311		(888)532-0311		(888)970-0917		(888)970-0917		(888)532-1183		(888)532-1183		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6067	801	0	1	01	01	H6067_801_0	6	1						05/23/2022	2023.01	05/23/2022 01:46:49 PM Eastern Daylight Time					06/06/2022 02:39:07 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	2023	Maryland		1	0	2			2									carefirstadvantage.com	carefirstadvantageformulary.com	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(888)532-0311		(888)532-0311		(888)970-0917		(888)970-0917		(888)532-1183		(888)532-1183		(711)-		(711)-		(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	6	1				0	0	05/23/2022	2023.01	05/23/2022 01:46:56 PM Eastern Daylight Time					06/06/2022 02:39:07 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	2023	Maryland		1	0	2			2									carefirstadvantage.com	carefirstadvantageformulary.com	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(888)532-0311		(888)532-0311										(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	6	1						05/23/2022	2023.01	05/23/2022 01:47:00 PM Eastern Daylight Time					06/06/2022 02:39:07 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	2023	Maryland		1	0	2			2									carefirstadvantage.com	carefirstadvantageformulary.com	www.carefirst.com/medicare	(888)532-1183		(888)532-1183		(888)532-0311		(888)532-0311		(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	6	1				0	0	05/23/2022	2023.01	05/23/2022 01:47:05 PM Eastern Daylight Time					06/06/2022 02:39:07 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	2023	Maryland		1	0	2			2									carefirstadvantage.com	carefirstadvantageformulary.com	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(888)532-0311		(888)532-0311										(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				
H6078	801	0	1	04	01	H6078_801_0	3	1						06/16/2022	2023.01	06/16/2022 02:43:30 PM Pacific Daylight Time					06/17/2022 08:13:58 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	2023	Pennsylvania National		1	720	2			2									BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	(833)434-1253		(833)434-1253		(833)434-1252		(833)434-1252		(833)409-1212		(833)409-1212		(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;15;16b;18a;	2		1									
H6078	802	0	1	04	01	H6078_802_0	3	1				0	0	06/16/2022	2023.01	06/16/2022 02:43:53 PM Pacific Daylight Time					06/17/2022 08:13:58 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	2023	Pennsylvania National		1	60180	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;15;16b;18a;	2		1									
H6078	803	0	1	04	01	H6078_803_0	2	1						05/23/2022	2023.01	05/23/2022 03:03:14 PM Pacific Daylight Time					06/03/2022 10:35:21 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	2023	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)409-1212		(833)409-1212		(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;15;16b;18a;	2		1									
H6078	804	0	1	04	01	H6078_804_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 03:03:20 PM Pacific Daylight Time					06/03/2022 10:35:21 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	2023	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;15;16b;18a;	2		1									
H6078	805	0	2	04	01	H6078_805_0	2	1						05/23/2022	2023.01	05/23/2022 03:03:27 PM Pacific Daylight Time					06/03/2022 10:35:21 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	2023	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)409-1212		(833)409-1212		(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;15;16b;18a;	2		1									
H6078	806	0	2	04	01	H6078_806_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 03:03:36 PM Pacific Daylight Time					06/03/2022 10:35:21 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	2023	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;15;16b;18a;	2		1									
H6079	001	0	1	20	08	H6079_001_0	1	1						06/02/2022	2023.01	06/02/2022 10:06:45 AM Mountain Daylight Time		05/27/2022 05:12:30 PM Mountain Daylight Time			06/02/2022 10:07:25 AM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge California PACE	www.MyInnovAge.com	InnovAge California PACE (PACE)	08	20		1			H6079	001	0	2023	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						06/02/2022	2023.01	06/02/2022 10:06:55 AM Mountain Daylight Time		05/27/2022 05:17:24 PM Mountain Daylight Time			06/02/2022 10:07:25 AM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge California PACE	www.MyInnovAge.com	InnovAge California PACE (PACE)	08	20		1			H6079	002	0	2023	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	5	1						07/28/2022	2023.01	07/28/2022 03:49:31 PM Eastern Daylight Time					07/29/2022 03:51:23 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	MeridianComplete	https://corp.mhplan.com/	Meridian Medicare-Medicaid Plan (MMP) (Medicare-Medicaid Plan)	05	48		1			H6080	001	0	2023	Greater Chicago		2	85000	2			2									https://corp.mhplan.com/	https://corp.mhplan.com/	https://corp.mhplan.com/	(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6154	001	0	1	02	01	H6154_001_0	5	1					1	08/04/2022	2023.01	08/04/2022 09:27:01 AM Central Daylight Time	08/04/2022 02:07:46 PM Central Daylight Time	08/04/2022 02:06:13 PM Central Daylight Time			08/04/2022 03:21:14 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H6154-001 (HMO-POS)	01	02		1			H6154	001	0	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 09:28:26 AM Central Daylight Time	08/04/2022 02:07:59 PM Central Daylight Time	08/04/2022 02:04:29 PM Central Daylight Time			08/04/2022 03:21:14 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H6154-002 (HMO-POS)	01	02		1			H6154	002	0	2023	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			
H6158	001	0	1	01	01	H6158_001_0	4	1					1	08/03/2022	2023.01	08/03/2022 08:07:21 AM Central Daylight Time	08/04/2022 01:08:37 PM Central Daylight Time	08/04/2022 01:08:42 PM Central Daylight Time			08/04/2022 01:42:16 PM Central Daylight Time	USABLE HMO, INC.	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H6158	001	0	2023	Select Counties in Arkansas		2		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	003	0	1	01	01	H6158_003_0	4	1						08/03/2022	2023.01	08/03/2022 08:21:42 AM Central Daylight Time	08/04/2022 01:08:48 PM Central Daylight Time	08/04/2022 01:08:53 PM Central Daylight Time			08/04/2022 01:42:16 PM Central Daylight Time	USABLE HMO, INC.	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Independence (HMO)	01	01		1			H6158	003	0	2023	Select Counties in Arkansas		2		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						06/02/2022	2023.01	06/02/2022 04:51:56 PM Eastern Daylight Time		06/03/2022 09:08:52 AM Eastern Daylight Time			06/03/2022 09:17:03 AM Eastern Daylight Time	VIECARE ARMSTRONG, LLC	LIFE Armstrong	www.lutheranseniorlife.org	VieCare Armstrong, LLC dba LIFE Armstrong County (PACE)	08	20		1			H6188	001	0	2023	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						06/02/2022	2023.01	06/02/2022 04:52:11 PM Eastern Daylight Time		06/03/2022 09:08:55 AM Eastern Daylight Time			06/03/2022 09:17:03 AM Eastern Daylight Time	VIECARE ARMSTRONG, LLC	LIFE Armstrong	www.lutheranseniorlife.org	VieCare Armstrong, LLC dba LIFE Armstrong County (PACE)	08	20		1			H6188	002	0	2023	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						08/01/2022	2023.01	08/01/2022 03:09:37 PM Eastern Daylight Time	08/03/2022 07:15:59 PM Central Daylight Time	07/30/2022 08:54:05 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H6193	001	0	2023	Select counties in MA		2		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			
H6200	001	0	1	04	01	H6200_001_0	8	1					1	08/03/2022	2023.01	08/03/2022 12:06:27 PM Central Daylight Time	08/08/2022 09:53:36 AM Central Daylight Time	08/03/2022 03:16:26 PM Central Daylight Time			08/08/2022 10:35:17 AM Central Daylight Time	ESSENCE HEALTHCARE PPO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Choice (PPO)	01	04		1			H6200	001	0	2023	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			
H6200	002	0	1	04	01	H6200_002_0	7	1					1	07/19/2022	2023.01	07/19/2022 09:31:02 AM Central Daylight Time	08/03/2022 03:42:30 PM Central Daylight Time	08/03/2022 03:47:16 PM Central Daylight Time			08/04/2022 09:44:57 AM Central Daylight Time	ESSENCE HEALTHCARE PPO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Choice Plus (PPO)	01	04		1			H6200	002	0	2023	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			
H6200	801	0	1	04	01	H6200_801_0	2	1						06/02/2022	2023.01	06/02/2022 12:07:16 PM Central Daylight Time					06/06/2022 03:20:26 PM Central Daylight Time	ESSENCE HEALTHCARE PPO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD Calendar Year (PPO)	01	04		1			H6200	801	0	2023	St. Louis Metropolitan 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									
H6200	802	0	1	04	01	H6200_802_0	2	1						06/02/2022	2023.01	06/02/2022 12:07:44 PM Central Daylight Time					06/06/2022 03:20:26 PM Central Daylight Time	ESSENCE HEALTHCARE PPO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD non-Calendar Year (PPO)	01	04		1			H6200	802	0	2023	St. Louis Metropolitan 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									
H6200	803	0	1	04	01	H6200_803_0	2	1				0	0	06/02/2022	2023.01	06/02/2022 12:08:14 PM Central Daylight Time					06/06/2022 03:20:26 PM Central Daylight Time	ESSENCE HEALTHCARE PPO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only Calendar Year (PPO)	01	04		1			H6200	803	0	2023	St. Louis Metropolitan 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									
H6200	804	0	1	04	01	H6200_804_0	2	1				0	0	06/02/2022	2023.01	06/02/2022 12:08:43 PM Central Daylight Time					06/06/2022 03:20:26 PM Central Daylight Time	ESSENCE HEALTHCARE PPO, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only non-Calendar Year (PPO)	01	04		1			H6200	804	0	2023	St. Louis Metropolitan 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									
H6202	001	0	1	04	01	H6202_001_0	8	1					1	08/05/2022	2023.01	08/05/2022 06:34:57 PM Eastern Daylight Time	08/05/2022 06:05:09 PM Eastern Daylight Time	08/05/2022 06:42:50 PM Eastern Daylight Time			08/05/2022 06:49:14 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	2023	North Dakota		2		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		(855)812-4306		(855)812-4306		(855)812-4306		(855)812-4306		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6202	002	0	1	04	01	H6202_002_0	8	1					1	08/05/2022	2023.01	08/05/2022 06:35:50 PM Eastern Daylight Time	08/05/2022 06:05:09 PM Eastern Daylight Time	08/05/2022 06:42:50 PM Eastern Daylight Time			08/05/2022 06:49:14 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	2023	North Dakota		2		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		(855)812-4306		(855)812-4306		(855)812-4306		(855)812-4306		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6202	003	0	1	04	01	H6202_003_0	5	1				0	0	07/08/2022	2023.01	07/08/2022 04:48:53 PM Eastern Daylight Time	06/06/2022 07:05:46 PM Eastern Daylight Time				07/08/2022 05:01:51 PM Eastern Daylight Time	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	NextBlue of North Dakota	www.nextblueND.com	NextBlue Freedom PPO (PPO)	01	04		1			H6202	003	0	2023	North Dakota		2		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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6202	801	0	1	04	01	H6202_801_0	4	1						05/24/2022	2023.01	05/24/2022 01:34:22 PM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)812-4306		(855)812-4306		(855)812-4306		(855)812-4306		(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	4	1						05/02/2022	2023.01	05/02/2022 11:22:47 AM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)812-4306		(855)812-4306		(855)812-4306		(855)812-4306		(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	5	1						06/16/2022	2023.01	06/16/2022 08:35:34 AM Eastern Daylight Time					06/16/2022 08:36:42 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	2023	State of North Dakota		1	660	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		(855)812-4306		(855)812-4306		(855)812-4306		(855)812-4306		(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	4	1				0	0	05/02/2022	2023.01	05/02/2022 11:21:46 AM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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									
H6231	001	0	1	20	08	H6231_001_0	1	1						06/01/2022	2023.01	06/01/2022 10:39:11 AM Central Daylight Time		06/01/2022 10:23:52 AM Central Daylight Time			06/01/2022 10:41:59 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.ololrmc.com	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	001	0	2023	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						06/01/2022	2023.01	06/01/2022 10:39:38 AM Central Daylight Time		06/01/2022 10:23:53 AM Central Daylight Time			06/01/2022 10:41:59 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.fmolhs.org	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	002	0	2023	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	6	1				0	0	07/06/2022	2023.01	07/06/2022 12:52:07 PM Pacific Daylight Time	06/01/2022 05:32:28 PM Pacific Daylight Time				07/11/2022 09:05:44 AM 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	2023	Select Counties in Oregon/Clark County, WA		2		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)-		(800)735-2900		(711)-										2					2					2	2			
H6237	007	1	1	01	01	H6237_007_1	9	1					1	08/04/2022	2023.01	08/04/2022 11:19:53 AM Pacific Daylight Time	08/04/2022 02:55:54 PM Pacific Daylight Time	08/01/2022 02:08:18 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark County, WA	Metro	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2					2	2			
H6237	007	3	1	01	01	H6237_007_3	9	1					1	08/04/2022	2023.01	08/04/2022 11:25:06 AM Pacific Daylight Time	08/04/2022 02:42:14 PM Pacific Daylight Time	08/01/2022 02:09:29 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark County, WA	Deschutes	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2					2	2			
H6237	008	1	1	01	01	H6237_008_1	8	1					1	08/04/2022	2023.01	08/04/2022 03:40:59 PM Pacific Daylight Time	08/04/2022 02:57:46 PM Pacific Daylight Time	08/01/2022 02:10:39 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark County, WA	Metro	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2					2	2			
H6237	008	3	1	01	01	H6237_008_3	8	1					1	08/04/2022	2023.01	08/04/2022 11:29:37 AM Pacific Daylight Time	08/04/2022 02:42:55 PM Pacific Daylight Time	08/01/2022 02:11:47 PM Pacific Daylight Time			08/05/2022 03:08:36 PM 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	2023	Select Counties in Oregon/Clark County, WA	Deschutes	2		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)-		(800)735-2900		(711)-		(711)-		(711)-		(800)735-2900		(711)-		2					2					2	2			
H6306	005	0	1	01	01	H6306_005_0	9	1						08/04/2022	2023.01	08/04/2022 03:12:29 PM Central Daylight Time	08/05/2022 11:18:56 AM Central Daylight Time	08/05/2022 11:18:56 AM Central Daylight Time			08/05/2022 12:25:58 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct SmartHMO (HMO)	01	01		1			H6306	005	0	2023	Wake County		2		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	10	1					1	08/04/2022	2023.01	08/04/2022 10:39:27 AM Central Daylight Time	08/03/2022 01:58:03 PM Central Daylight Time	08/04/2022 12:43:12 PM Central Daylight Time			08/05/2022 11:07:56 AM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Plus (HMO-POS)	01	02		1			H6306	011	1	2023	North Carolina	Sandhills	2		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	12	1					1	08/04/2022	2023.01	08/04/2022 10:40:11 AM Central Daylight Time	08/03/2022 02:05:55 PM Central Daylight Time	08/04/2022 12:43:38 PM Central Daylight Time			08/05/2022 11:07:56 AM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Plus (HMO-POS)	01	02		1			H6306	011	3	2023	North Carolina	Western North Carolina	2		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	12	1					1	08/04/2022	2023.01	08/04/2022 10:40:44 AM Central Daylight Time	08/04/2022 01:05:17 PM Central Daylight Time	08/04/2022 12:44:00 PM Central Daylight Time			08/05/2022 11:07:56 AM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Standard (HMO-POS)	01	02		1			H6306	012	1	2023	North Carolina	Sandhills	2		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	12	1					1	08/04/2022	2023.01	08/04/2022 10:41:27 AM Central Daylight Time	08/04/2022 01:05:44 PM Central Daylight Time	08/04/2022 12:44:22 PM Central Daylight Time			08/05/2022 11:07:56 AM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Standard (HMO-POS)	01	02		1			H6306	012	5	2023	North Carolina	Western North Carolina	2		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	7	1						08/05/2022	2023.01	08/05/2022 11:35:05 AM Central Daylight Time	08/05/2022 07:56:12 AM Central Daylight Time	08/03/2022 01:14:05 PM Central Daylight Time			08/05/2022 11:38:21 AM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.FirstCarolinaCare.com/NHHA	New Hanover Health Advantage Select (HMO-POS)	01	02		1			H6306	013	0	2023	New Hanover, Pender, and Brunswick counties		2		2			2									www.FirstCarolinaCare.com/NHHA	www.FirstCarolinaCare.com/NHHA	www.FirstCarolinaCare.com/NHHA	(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	8	1						07/12/2022	2023.01	07/12/2022 11:56:21 AM Central Daylight Time	08/03/2022 01:14:05 PM Central Daylight Time	08/03/2022 01:14:05 PM Central Daylight Time			08/05/2022 11:38:21 AM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.FirstCarolinaCare.com/NHHA	New Hanover Health Advantage Platinum (HMO-POS)	01	02		1			H6306	014	0	2023	New Hanover, Pender, and Brunswick counties		2		2			2									www.FirstCarolinaCare.com/NHHA	www.FirstCarolinaCare.com/NHHA	www.FirstCarolinaCare.com/NHHA	(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	9	1				0	0	07/12/2022	2023.01	07/12/2022 12:00:50 PM Central Daylight Time	07/17/2022 03:16:42 PM Central Daylight Time				07/18/2022 02:10:24 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Choice (HMO-POS)	01	02		1			H6306	015	0	2023	Sandhills		2		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			
H6306	016	0	1	02	01	H6306_016_0	4	1				0	0	07/12/2022	2023.01	07/12/2022 12:03:00 PM Central Daylight Time	06/02/2022 08:31:56 PM Central Daylight Time				07/13/2022 04:18:52 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.FirstCarolinaCare.com/NHHA	New Hanover Health Advantage Freedom (HMO-POS)	01	02		1			H6306	016	0	2023	New Hanover, Pender, and Brunswick counties		2		2			2									www.FirstCarolinaCare.com/NHHA	www.FirstCarolinaCare.com/NHHA	www.FirstCarolinaCare.com/NHHA	(855)291-9336		(855)291-9336		(888)384-4842		(888)384-4842										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6306	801	0	1	02	01	H6306_801_0	2	1				0	0	04/27/2022	2023.01	04/27/2022 09:17:12 AM Central Daylight Time					05/31/2022 03:56:46 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	Medicare Employer HMO-POS (HMO-POS)	01	02		1			H6306	801	0	2023	North Carolina		1	0	1	1		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)-										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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H6306	802	0	1	02	01	H6306_802_0	2	1						04/27/2022	2023.01	04/27/2022 09:16:53 AM Central Daylight Time					05/31/2022 03:56:46 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	Medicare Employer HMO-POS Rx (HMO-POS)	01	02		1			H6306	802	0	2023	North Carolina		1	0	1	1		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)-		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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H6306	803	0	1	02	01	H6306_803_0	2	1						04/27/2022	2023.01	04/27/2022 09:16:38 AM Central Daylight Time					05/31/2022 03:56:46 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	Medicare Employer HMO-POS Rx - non-calendar year (HMO-POS)	01	02		1			H6306	803	0	2023	North Carolina		1	0	1	1		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)-		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;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H6316	002	0	1	01	01	H6316_002_0	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:07:24 PM Venezuela Standard Time	08/04/2022 06:17:48 PM Venezuela Standard Time	08/04/2022 06:31:59 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard Time	MISSOURI CARE, INCORPORATED	Healthy Blue	https://shop.healthybluemo.com/medicare	Healthy Blue Dual (HMO D-SNP)	01	01		1			H6316	002	0	2023	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	7	1					1	08/02/2022	2023.01	08/02/2022 02:44:12 PM Eastern Daylight Time	08/04/2022 08:50:06 AM Eastern Daylight Time	08/03/2022 10:45:52 AM Eastern Daylight Time			08/04/2022 08:34:44 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org/medicare	McLaren Medicare Inspire (HMO)	01	01		1			H6322	001	0	2023	Lower Peninsula of Michigan		2		2			2									www.mclarenhealthplan.org	www.mclarenhealthplan.org/medicare	www.mclarenhealthplan.org/medicare	(833)358-2404		(317)822-7402		(833)358-2404		(317)822-7402		(844)336-2678		(317)822-7402		(833)358-2404		(317)822-7402		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	002	0	1	01	01	H6322_002_0	7	1					1	08/02/2022	2023.01	08/02/2022 02:45:36 PM Eastern Daylight Time	08/04/2022 08:51:12 AM Eastern Daylight Time	08/03/2022 10:47:28 AM Eastern Daylight Time			08/04/2022 08:34:44 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org/medicare	McLaren Medicare Inspire Plus (HMO)	01	01		1			H6322	002	0	2023	Lower Peninsula of Michigan		2		2			2									www.mclarenhealthplan.org	www.mclarenhealthplan.org/medicare	www.mclarenhealthplan.org/medicare	(833)358-2404		(317)822-7402		(833)358-2404		(317)822-7402		(844)336-2678		(317)822-7402		(833)358-2404		(317)822-7402		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	003	1	1	02	01	H6322_003_1	7	1					1	08/02/2022	2023.01	08/02/2022 02:49:01 PM Eastern Daylight Time	08/04/2022 08:52:20 AM Eastern Daylight Time	08/03/2022 10:48:10 AM Eastern Daylight Time			08/04/2022 08:34:44 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org/medicare	McLaren Medicare Inspire Flex (HMO-POS)	01	02		1			H6322	003	1	2023	Lower Peninsula of Michigan	Region 1 - Select Lower MI Counties	2		2			2									www.mclarenhealthplan.org	www.mclarenhealthplan.org/medicare	www.mclarenhealthplan.org/medicare	(833)358-2404		(317)822-7402		(833)358-2404		(317)822-7402		(844)336-2678		(317)822-7402		(833)358-2404		(317)822-7402		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	003	2	1	02	01	H6322_003_2	7	1					1	08/02/2022	2023.01	08/02/2022 02:48:26 PM Eastern Daylight Time	08/04/2022 08:53:28 AM Eastern Daylight Time	08/03/2022 10:48:54 AM Eastern Daylight Time			08/04/2022 08:34:44 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org/medicare	McLaren Medicare Inspire Flex (HMO-POS)	01	02		1			H6322	003	2	2023	Lower Peninsula of Michigan	Region 2 - Select Lower MI Counties	2		2			2									www.mclarenhealthplan.org	www.mclarenhealthplan.org/medicare	www.mclarenhealthplan.org/medicare	(833)358-2404		(317)822-7402		(833)358-2404		(317)822-7402		(844)336-2678		(317)822-7402		(833)358-2404		(317)822-7402		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	004	0	1	01	01	H6322_004_0	7	1	2	1			0	08/02/2022	2023.01	08/02/2022 02:52:40 PM Eastern Daylight Time	08/04/2022 08:54:36 AM Eastern Daylight Time	08/03/2022 10:50:08 AM Eastern Daylight Time			08/04/2022 08:34:44 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org/medicare	McLaren Medicare Inspire Duals (HMO D-SNP)	01	01		1			H6322	004	0	2023	Lower Peninsula of Michigan DSNP		2		2			1	3		1					1	www.mclarenhealthplan.org	www.mclarenhealthplan.org/medicare	www.mclarenhealthplan.org/medicare	(833)358-2404		(317)822-7402		(833)358-2404		(317)822-7402		(844)336-2678		(317)822-7402		(833)358-2404		(317)822-7402		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	801	0	1	01	01	H6322_801_0	5	1						05/16/2022	2023.01	05/16/2022 12:40:34 PM Eastern Daylight Time					06/06/2022 02:55:34 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org/medicare	McLaren Medicare EGWP CY (HMO)	01	01		1			H6322	801	0	2023	Michigan EGWP Area		1	2040	2			2									www.mclarenhealthplan.org	www.mclarenhealthplan.org	www.mclarenhealthplan.org/medicare	(833)358-2404		(317)822-7402		(833)358-2404		(317)822-7402		(844)336-2678		(317)822-7402		(833)358-2404		(317)822-7402		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	803	0	1	01	01	H6322_803_0	5	1				0	0	05/16/2022	2023.01	05/16/2022 01:06:23 PM Eastern Daylight Time					06/06/2022 02:55:34 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org/medicare	McLaren Medicare EGWP MA-Only (HMO)	01	01		1			H6322	803	0	2023	Michigan EGWP Area		1	938	2			2									www.mclarenhealthplan.org	www.mclarenhealthplan.org	www.mclarenhealthplan.org/medicare	(833)358-2404		(317)822-7402		(833)358-2404		(317)822-7402										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6328	001	0	1	04	01	H6328_001_0	5	1					1	08/03/2022	2023.01	08/03/2022 11:24:55 AM Mountain Daylight Time	08/04/2022 10:31:54 AM Mountain Daylight Time	08/02/2022 07:04:56 PM Mountain Daylight Time			08/04/2022 01:20:40 PM Mountain 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	2023	Dallas/Fort Worth Metro Area		2		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	08/03/2022	2023.01	08/03/2022 11:25:49 AM Mountain Daylight Time	08/04/2022 10:32:34 AM Mountain Daylight Time	08/02/2022 07:05:30 PM Mountain Daylight Time			08/04/2022 01:20:40 PM Mountain 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	2023	Dallas/Fort Worth Metro Area		2		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	08/03/2022	2023.01	08/03/2022 11:26:45 AM Mountain Daylight Time	08/04/2022 10:33:14 AM Mountain Daylight Time	08/02/2022 07:06:05 PM Mountain Daylight Time			08/04/2022 01:20:40 PM Mountain 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	2023	Dallas/Fort Worth Metro Area		2		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	4	1				0	0	06/29/2022	2023.01	06/29/2022 10:54:22 AM Mountain Daylight Time	06/04/2022 02:34:39 PM Mountain Daylight Time				07/11/2022 12:36:56 PM Mountain 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	2023	Dallas/Fort Worth Metro Area		2		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	4	1						06/29/2022	2023.01	06/29/2022 10:55:31 AM Mountain Daylight Time					07/11/2022 12:36:56 PM Mountain 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	2023	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	4	1						06/29/2022	2023.01	06/29/2022 10:56:25 AM Mountain Daylight Time					07/11/2022 12:36:56 PM Mountain 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	2023	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	4	1				0	0	06/29/2022	2023.01	06/29/2022 10:57:07 AM Mountain Daylight Time					07/11/2022 12:36:56 PM Mountain 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	2023	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	4	1				0	0	06/29/2022	2023.01	06/29/2022 10:57:57 AM Mountain Daylight Time					07/11/2022 12:36:56 PM Mountain 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	2023	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						06/02/2022	2023.01	06/02/2022 11:33:35 AM Central Daylight Time		06/01/2022 12:53:53 PM Central Daylight Time			06/02/2022 11:35:51 AM 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	2023	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						06/02/2022	2023.01	06/02/2022 11:34:13 AM Central Daylight Time		06/01/2022 12:53:53 PM Central Daylight Time			06/02/2022 11:35:51 AM 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	2023	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	6	1		1				08/02/2022	2023.01	08/02/2022 08:52:18 PM Central Daylight Time	08/03/2022 11:42:20 AM Central Daylight Time	08/02/2022 11:19:31 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier (HMO I-SNP)	01	01		1			H6345	001	0	2023	NC (Partial)		2		2			1	1	3							www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6345	002	0	1	01	01	H6345_002_0	5	1		1				08/02/2022	2023.01	08/02/2022 08:56:24 PM Central Daylight Time	08/03/2022 11:42:54 AM Central Daylight Time	08/02/2022 11:20:57 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier (HMO I-SNP)	01	01		1			H6345	002	0	2023	South Carolina (partial)		2		2			1	1	3							www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(855)855-0759		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6348	002	0	1	04	01	H6348_002_0	4	1						08/03/2022	2023.01	08/03/2022 04:01:02 PM Eastern Daylight Time	08/03/2022 09:09:50 PM Eastern Daylight Time	07/30/2022 09:54:37 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	Select counties in IN		2		2			2									www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	005	0	1	04	01	H6348_005_0	3	1				0	0	05/29/2022	2023.01	05/29/2022 11:26:59 AM Eastern Daylight Time	06/03/2022 08:25:05 PM Eastern Daylight Time				07/15/2022 04:25:45 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	2023	Select counites in IN		2		2			2									www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6348	006	0	1	04	01	H6348_006_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 02:52:43 PM Eastern Daylight Time	08/03/2022 09:12:08 PM Eastern Daylight Time	07/30/2022 09:55:10 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H6348	006	0	2023	All counties in IN		2		2			1	3		1					1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)202-4704		(833)202-4704		(844)917-0175		(844)917-0175		(833)202-4704		(833)202-4704		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	007	0	1	04	01	H6348_007_0	5	1						08/01/2022	2023.01	08/01/2022 03:24:42 PM Eastern Daylight Time	08/03/2022 09:18:25 PM Eastern Daylight Time	07/30/2022 09:55:41 AM Eastern Daylight Time			08/04/2022 05:38:39 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare Low Premium Open (PPO)	01	04		1			H6348	007	0	2023	Select counties in IN		2		2			2									www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	801	0	1	04	01	H6348_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:18:22 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	01	04		1			H6348	801	0	2023	Indiana		1	100	2			2									allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:18:27 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	01	04		1			H6348	802	0	2023	Indiana		1	100	2			2									allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:18:35 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	01	04		1			H6348	803	0	2023	Indiana		1	100	2			2									allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(855)766-1541		(855)766-1541		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	4	1		1				08/02/2022	2023.01	08/02/2022 08:44:23 PM Central Daylight Time	08/03/2022 11:43:31 AM Central Daylight Time	08/02/2022 11:22:23 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Medicare Advantage	http://www.libertymedicareadvantage.com	Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)	01	01		1			H6351	001	0	2023	North Carolina (partial)		2		2			1	1	3							http://www.navitus.com/	http://www.libertymedicareadvantage.com	http://www.libertymedicareadvantage.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	5	1		1				08/03/2022	2023.01	08/03/2022 03:13:33 PM Central Daylight Time	08/03/2022 11:44:08 AM Central Daylight Time	08/02/2022 11:23:49 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Medicare Advantage	http://www.libertymedicareadvantage.com	Liberty Medicare Advantage (HMO C-SNP)	01	01		1			H6351	004	0	2023	North Carolina (partial)		2		2			1	4			00000000000000000010000					http://www.libertymedicareadvantage.com	http://www.libertymedicareadvantage.com	http://www.libertymedicareadvantage.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	5	1	2	1			0	08/03/2022	2023.01	08/03/2022 03:11:25 PM Central Daylight Time	08/03/2022 11:44:45 AM Central Daylight Time	08/02/2022 11:25:14 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Medicare Advantage	http://www.libertymedicareadvantage.com	Liberty Medicare Dual Plan (HMO D-SNP)	01	01		1			H6351	005	0	2023	North Carolina (partial)		2		2			1	3		2					2	http://www.libertymedicareadvantage.com	http://www.libertymedicareadvantage.com	http://www.libertymedicareadvantage.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						06/01/2022	2023.01	06/01/2022 06:58:12 AM Eastern Daylight Time		05/31/2022 03:32:56 PM Eastern Daylight Time			06/01/2022 07:00:54 AM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lifelsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	001	0	2023	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						06/01/2022	2023.01	06/01/2022 06:58:38 AM Eastern Daylight Time		05/31/2022 03:35:00 PM Eastern Daylight Time			06/01/2022 07:00:54 AM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lifelsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	002	0	2023	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																
H6378	001	0	1	01	01	H6378_001_0	6	1	2	1			0	08/03/2022	2023.01	08/03/2022 02:18:14 PM Eastern Daylight Time	08/04/2022 11:08:03 AM Eastern Daylight Time	08/04/2022 11:08:03 AM Eastern Daylight Time			08/04/2022 11:14:44 AM Eastern Daylight Time	AMERIHEALTH CARITAS FLORIDA INC	AmeriHealth Caritas VIP Care	www.amerihealthcaritasvipcare.com	AmeriHealth Caritas VIP Care (HMO D-SNP)	01	01		1			H6378	001	0	2023	Palm Beach, Broward, Miami-Dade		2		2			1	3		1					1	www.amerihealthcaritasvipcare.com	www.amerihealthcaritasvipcare.com	www.amerihealthcaritasvipcare.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			
H6379	001	0	1	01	01	H6379_001_0	6	1					1	08/03/2022	2023.01	08/03/2022 07:56:15 AM Central Daylight Time	08/04/2022 03:17:12 PM Central Daylight Time	08/04/2022 03:38:08 PM Central Daylight Time			08/04/2022 04:25:51 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	2023	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	005	0	1	01	01	H6396_005_0	9	1	2	1			0	08/02/2022	2023.01	08/02/2022 10:59:11 AM Central Daylight Time	08/03/2022 10:04:32 AM Central Daylight Time	08/03/2022 09:35:26 AM Central Daylight Time			08/05/2022 01:43:08 PM Central Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H6396	005	0	2023	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	014	0	1	01	01	H6396_014_0	8	1	2	1			0	08/03/2022	2023.01	08/03/2022 07:46:14 AM Central Daylight Time	08/03/2022 10:05:50 AM Central Daylight Time	08/03/2022 09:40:14 AM Central Daylight Time			08/05/2022 01:43:08 PM Central Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H6396	014	0	2023	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	8	1	2	1			0	08/03/2022	2023.01	08/03/2022 07:47:18 AM Central Daylight Time	08/03/2022 10:03:00 AM Central Daylight Time	08/03/2022 09:39:08 AM Central Daylight Time			08/05/2022 01:43:08 PM Central Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H6396	015	0	2023	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	4	1	2	1	1		0	05/27/2022	2023.01	05/27/2022 10:22:17 AM Central Daylight Time	08/02/2022 04:14:52 PM Central Daylight Time	07/31/2022 11:45:10 PM Central Daylight Time			08/04/2022 03:58:19 PM Central 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	2023	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			
H6408	001	0	1	01	01	H6408_001_0	4	1					0	08/04/2022	2023.01	08/04/2022 10:24:56 AM Eastern Daylight Time	08/04/2022 05:54:00 PM Eastern Daylight Time	08/04/2022 05:54:01 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Trinity Health Plan Of New England	www.medigold.com	Trinity Health Plan Of New England No Premium (HMO)	01	01		1			H6408	001	0	2023	Select Counties in Connecticut		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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			
H6408	002	0	1	01	01	H6408_002_0	4	1					0	08/04/2022	2023.01	08/04/2022 10:26:12 AM Eastern Daylight Time	08/04/2022 05:54:01 PM Eastern Daylight Time	08/04/2022 05:54:01 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Trinity Health Plan Of New England	www.medigold.com	Trinity Health Plan Of New England Cash Back MAPD (HMO)	01	01		1			H6408	002	0	2023	Select Counties in Connecticut		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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			
H6408	003	0	1	01	01	H6408_003_0	3	1				0	0	07/12/2022	2023.01	07/12/2022 07:14:15 AM Eastern Daylight Time	06/06/2022 05:18:42 AM Eastern Daylight Time				07/12/2022 08:35:24 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Trinity Health Plan Of New England	www.medigold.com	Trinity Health Plan Of New England Cash Back (HMO)	01	01		1			H6408	003	0	2023	Select Counties in Connecticut		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	www.medigold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6408	801	0	1	01	01	H6408_801_0	2	1						05/26/2022	2023.01	05/26/2022 02:36:45 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Trinity Health Plan Of New England	www.medigold.com	Trinity Health Plan Of New England EGWP 1 (HMO)	01	01		1			H6408	801	0	2023	Select Counties in Connecticut		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H6408	802	0	1	01	01	H6408_802_0	2	1						05/26/2022	2023.01	05/26/2022 02:41:20 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Trinity Health Plan Of New England	www.medigold.com	Trinity Health Plan Of New England EGWP 2 (HMO)	01	01		1			H6408	802	0	2023	Select Counties in Connecticut		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H6425	001	0	1	20	08	H6425_001_0	1	1						06/02/2022	2023.01	06/02/2022 04:44:52 PM Central Daylight Time		06/02/2022 05:03:28 PM Central Daylight Time			06/02/2022 05:06:27 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	2023	Northwest Arkansas		2		2			2									https://www.collierdrug.com	N/A												(479)463-6600				(479)463-6600												(711)-				(711)-																
H6425	002	0	1	20	08	H6425_002_0	1	1						06/02/2022	2023.01	06/02/2022 04:45:18 PM Central Daylight Time		06/02/2022 05:03:28 PM Central Daylight Time			06/02/2022 05:06:27 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	2023	Northwest Arkansas		2		2			2									https://www.collierdrug.com	N/A												(479)463-6600				(479)463-6600												(711)-				(711)-																
H6446	001	0	1	01	01	H6446_001_0	4	1						08/01/2022	2023.01	08/01/2022 03:43:14 PM Eastern Daylight Time	08/03/2022 05:18:55 PM Pacific Daylight Time	07/30/2022 06:56:13 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare No Premium (HMO)	01	01		1			H6446	001	0	2023	Select counties in NV		2		2			2									www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	003	0	1	01	01	H6446_003_0	4	1						08/03/2022	2023.01	08/03/2022 02:41:01 PM Eastern Daylight Time	08/03/2022 05:21:28 PM Pacific Daylight Time	07/30/2022 06:56:45 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Giveback (HMO)	01	01		1			H6446	003	0	2023	Select counties in NV		2		2			2									www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	005	0	1	01	01	H6446_005_0	4	1						08/03/2022	2023.01	08/03/2022 02:42:46 PM Eastern Daylight Time	08/03/2022 05:33:12 PM Pacific Daylight Time	07/30/2022 06:57:16 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Giveback (HMO)	01	01		1			H6446	005	0	2023	Select counties in NV		2		2			2									www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	010	0	1	01	01	H6446_010_0	4	1						08/03/2022	2023.01	08/03/2022 02:44:00 PM Eastern Daylight Time	08/03/2022 05:34:19 PM Pacific Daylight Time	07/30/2022 06:57:48 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare No Premium (HMO)	01	01		1			H6446	010	0	2023	Select counties in NV		2		2			2									www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	011	0	1	01	01	H6446_011_0	4	1						05/26/2022	2023.01	05/26/2022 10:45:40 AM Eastern Daylight Time	08/03/2022 05:35:28 PM Pacific Daylight Time	07/30/2022 06:58:19 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Assist (HMO)	01	01		1			H6446	011	0	2023	Select counties in NV		2		2			2									www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	013	0	1	01	01	H6446_013_0	4	1			2		0	05/26/2022	2023.01	05/26/2022 10:47:34 AM Eastern Daylight Time	08/03/2022 05:53:29 PM Pacific Daylight Time	07/30/2022 06:58:51 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Assist (HMO)	01	01		1			H6446	013	0	2023	Select counties in NV		2		2			2									www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	014	0	1	01	01	H6446_014_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:12:39 AM Eastern Daylight Time	08/03/2022 05:50:55 PM Pacific Daylight Time	07/30/2022 06:59:24 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Dual Access (HMO D-SNP)	01	01		1			H6446	014	0	2023	Select counties in NV		2		2			1	3		1					1	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)717-0806		(833)717-0806		(844)917-0175		(844)917-0175		(833)717-0806		(833)717-0806		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	016	0	1	01	01	H6446_016_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:15:51 AM Eastern Daylight Time	08/03/2022 05:49:31 PM Pacific Daylight Time	07/30/2022 06:59:56 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Dual Access (HMO D-SNP)	01	01		1			H6446	016	0	2023	Select counties in NV		2		2			1	3		1					1	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)717-0806		(833)717-0806		(844)917-0175		(844)917-0175		(833)717-0806		(833)717-0806		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	017	0	1	01	01	H6446_017_0	4	1		1	2		1	08/03/2022	2023.01	08/03/2022 02:45:24 PM Eastern Daylight Time	08/03/2022 05:46:24 PM Pacific Daylight Time	07/30/2022 07:00:28 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H6446	017	0	2023	Select counties in NV		2		2			1	4			00000000000000000010000					www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	005	0	1	01	01	H6453_005_0	6	1						08/09/2022	2023.01	08/09/2022 08:51:59 AM Central Daylight Time	08/04/2022 12:13:48 PM Central Daylight Time	08/03/2022 03:50:50 PM Central Daylight Time			08/09/2022 01:07:30 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	005	0	2023	Northwest Parishes		2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	006	0	1	01	01	H6453_006_0	7	1						08/09/2022	2023.01	08/09/2022 08:52:19 AM Central Daylight Time	08/04/2022 12:14:32 PM Central Daylight Time	08/03/2022 03:51:26 PM Central Daylight Time			08/09/2022 01:07:30 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	006	0	2023	Northeast Parishes		2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	007	1	1	01	01	H6453_007_1	5	1						08/09/2022	2023.01	08/09/2022 08:52:34 AM Central Daylight Time	08/04/2022 12:15:18 PM Central Daylight Time	08/03/2022 03:52:00 PM Central Daylight Time			08/09/2022 01:07:30 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	007	1	2023	Baton Rouge	Ascension, East Baton Rouge	2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	007	2	1	01	01	H6453_007_2	7	1						08/09/2022	2023.01	08/09/2022 08:52:47 AM Central Daylight Time	08/05/2022 08:19:00 AM Central Daylight Time	08/03/2022 03:52:34 PM Central Daylight Time			08/09/2022 01:07:30 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	007	2	2023	Baton Rouge	West Baton Rouge Parishes, Select Parishes	2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	008	1	1	01	01	H6453_008_1	5	1						08/09/2022	2023.01	08/09/2022 08:53:01 AM Central Daylight Time	08/04/2022 12:16:46 PM Central Daylight Time	08/03/2022 03:53:10 PM Central Daylight Time			08/09/2022 01:07:30 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	008	1	2023	Greater New Orleans	Terrebonne, Lafourche, Greater New Orleans	2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	008	2	1	01	01	H6453_008_2	6	1						08/09/2022	2023.01	08/09/2022 08:53:14 AM Central Daylight Time	08/04/2022 12:17:30 PM Central Daylight Time	08/03/2022 03:53:44 PM Central Daylight Time			08/09/2022 01:07:30 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	008	2	2023	Greater New Orleans	Assumption, Plaquemines, Select Parishes	2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	009	1	1	01	01	H6453_009_1	5	1						08/09/2022	2023.01	08/09/2022 08:53:29 AM Central Daylight Time	08/04/2022 12:18:14 PM Central Daylight Time	08/03/2022 03:54:18 PM Central Daylight Time			08/09/2022 01:07:30 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	009	1	2023	North Shore	St. Tammany, Tangipahoa	2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	009	2	1	01	01	H6453_009_2	6	1						08/09/2022	2023.01	08/09/2022 08:53:43 AM Central Daylight Time	08/04/2022 12:18:58 PM Central Daylight Time	08/03/2022 03:54:52 PM Central Daylight Time			08/09/2022 01:07:30 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	009	2	2023	North Shore	Washington	2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	010	1	1	01	01	H6453_010_1	5	1						08/09/2022	2023.01	08/09/2022 08:53:55 AM Central Daylight Time	08/04/2022 12:19:42 PM Central Daylight Time	08/03/2022 03:55:24 PM Central Daylight Time			08/09/2022 01:07:30 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	010	1	2023	Acadiana	Rapides, Calcasieu, Greater Lafayette Parishes	2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	010	2	1	01	01	H6453_010_2	6	1						08/09/2022	2023.01	08/09/2022 08:54:07 AM Central Daylight Time	08/04/2022 12:20:24 PM Central Daylight Time	08/03/2022 03:55:56 PM Central Daylight Time			08/09/2022 01:07:30 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	010	2	2023	Acadiana	Avoyelles, Grant, St. Mary, Southwest Parishes	2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	011	0	1	01	01	H6453_011_0	6	1						08/09/2022	2023.01	08/09/2022 08:54:21 AM Central Daylight Time	08/04/2022 12:21:10 PM Central Daylight Time	08/03/2022 03:56:26 PM Central Daylight Time			08/09/2022 01:07:30 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	011	0	2023	State of Louisiana		2		2			2									www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	801	0	1	01	01	H6453_801_0	2	1						05/18/2022	2023.01	05/18/2022 08:08:42 PM Central Daylight Time					06/01/2022 10:13:48 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	801	0	2023	State of Louisiana		1	8560	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	802	0	1	01	01	H6453_802_0	2	1						05/27/2022	2023.01	05/27/2022 11:29:23 AM Central Daylight Time					06/01/2022 10:13:48 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	802	0	2023	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)-		2					2					2	2			
H6453	803	0	1	01	01	H6453_803_0	2	1				0	0	04/12/2022	2023.01	04/12/2022 10:46:17 AM Central Daylight Time					06/01/2022 10:13:48 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	803	0	2023	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)-										2					2					2	2			
H6502	002	0	1	04	01	H6502_002_0	5	1					1	08/03/2022	2023.01	08/03/2022 08:24:16 AM Eastern Daylight Time	08/04/2022 05:50:54 PM Eastern Daylight Time	08/04/2022 05:50:54 PM Eastern Daylight Time			08/04/2022 06:15:53 PM Eastern Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue KC Essential (PPO)	01	04		1			H6502	002	0	2023	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	8	1				0	0	08/02/2022	2023.01	08/02/2022 09:47:31 AM Eastern Daylight Time	06/28/2022 07:10:06 PM Eastern Daylight Time				08/05/2022 09:05:51 AM Eastern Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue KC Valor (PPO)	01	04		1			H6502	003	0	2023	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	7	1					1	08/03/2022	2023.01	08/03/2022 08:24:59 AM Eastern Daylight Time	08/04/2022 05:50:54 PM Eastern Daylight Time	08/04/2022 05:50:54 PM Eastern Daylight Time			08/04/2022 06:15:53 PM Eastern Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue KC Simply Blue (PPO)	01	04		1			H6502	004	0	2023	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	6	1					1	08/03/2022	2023.01	08/03/2022 08:25:42 AM Eastern Daylight Time	08/04/2022 05:50:55 PM Eastern Daylight Time	08/04/2022 05:50:55 PM Eastern Daylight Time			08/04/2022 06:15:53 PM Eastern Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue KC Giveback (PPO)	01	04		1			H6502	005	0	2023	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	2	1				0	0	05/31/2022	2023.01	05/31/2022 12:53:11 PM Eastern Daylight Time					05/31/2022 01:03:54 PM Eastern 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	2023	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	3	1						07/18/2022	2023.01	07/18/2022 03:29:03 PM Eastern Daylight Time					07/19/2022 01:49:48 PM Eastern 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	2023	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	2	1						05/31/2022	2023.01	05/31/2022 12:53:34 PM Eastern Daylight Time					05/31/2022 01:03:54 PM Eastern 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	2023	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	02	01	H6526_001_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:52:11 AM Central Daylight Time	08/03/2022 12:01:31 PM Central Daylight Time	07/31/2022 03:32:55 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW MEXICO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H6526	001	0	2023	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	02	01	H6526_002_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:52:57 AM Central Daylight Time	08/03/2022 12:02:09 PM Central Daylight Time	07/31/2022 03:33:20 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW MEXICO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H6526	002	0	2023	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	08/03/2022	2023.01	08/03/2022 12:14:17 PM Central Daylight Time	08/03/2022 10:44:40 AM Central Daylight Time	07/31/2022 03:33:45 AM Central Daylight Time			08/04/2022 04:34:56 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	2023	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	08/03/2022	2023.01	08/03/2022 12:15:02 PM Central Daylight Time	08/03/2022 10:45:14 AM Central Daylight Time	07/31/2022 03:34:09 AM Central Daylight Time			08/04/2022 04:34:56 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	2023	Northwest 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			
H6528	033	0	1	04	01	H6528_033_0	2	1			1		1	08/04/2022	2023.01	08/04/2022 11:48:59 AM Central Daylight Time	08/03/2022 10:45:46 AM Central Daylight Time	07/31/2022 03:34:34 AM Central Daylight Time			08/04/2022 04:34:56 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	2023	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	2	1			2		1	08/02/2022	2023.01	08/02/2022 02:25:38 PM Central Daylight Time	08/03/2022 10:46:19 AM Central Daylight Time	07/31/2022 03:34:59 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H6528	035	0	2023	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			
H6528	036	0	1	04	01	H6528_036_0	2	1			2		1	08/02/2022	2023.01	08/02/2022 02:29:58 PM Central Daylight Time	08/03/2022 10:46:51 AM Central Daylight Time	07/31/2022 03:35:24 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H6528	036	0	2023	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			
H6528	037	0	1	04	01	H6528_037_0	1	1			2	0	0	06/01/2022	2023.01	06/01/2022 02:45:08 PM Central Daylight Time	06/01/2022 11:12:30 AM Central Daylight Time				06/02/2022 01:13:21 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Medicare Advantage Patriot (PPO)	01	04		1			H6528	037	0	2023	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6528	038	0	1	04	01	H6528_038_0	2	1		1	2		1	08/03/2022	2023.01	08/03/2022 12:16:35 PM Central Daylight Time	08/03/2022 10:47:23 AM Central Daylight Time	07/31/2022 03:35:48 AM Central Daylight Time			08/04/2022 04:34:56 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Chronic Complete (PPO C-SNP)	01	04		1			H6528	038	0	2023	Select counties in Arkansas		2		2			1	4			00000000000000000010000					www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6528	039	0	1	04	01	H6528_039_0	2	1		1	2		1	08/04/2022	2023.01	08/04/2022 11:47:42 AM Central Daylight Time	08/03/2022 10:47:55 AM Central Daylight Time	07/31/2022 03:36:13 AM Central Daylight Time			08/04/2022 04:34:56 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Chronic Complete (PPO C-SNP)	01	04		1			H6528	039	0	2023	Select Counties in Georgia		2		2			1	4			00000000000000000010000					www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6528	041	0	1	04	01	H6528_041_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:22:55 PM Central Daylight Time	08/03/2022 10:48:28 AM Central Daylight Time	07/31/2022 03:36:38 AM Central Daylight Time			08/04/2022 04:34:56 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Rebate (PPO)	01	04		1			H6528	041	0	2023	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			
H6529	001	1	1	01	01	H6529_001_1	6	1					1	08/04/2022	2023.01	08/04/2022 06:06:28 PM Central Daylight Time	08/04/2022 04:55:12 PM Central Daylight Time	08/04/2022 01:48:04 PM Central Daylight Time			08/04/2022 10:00:23 PM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Select (HMO)	01	01		1			H6529	001	1	2023	Indiana (Partial)	Columbus, N Vernon, S Indianapolis, Terre Haute	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		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		2					2					2	2			
H6529	001	2	1	01	01	H6529_001_2	6	1					1	08/04/2022	2023.01	08/04/2022 06:06:54 PM Central Daylight Time	08/04/2022 05:03:03 PM Central Daylight Time	08/04/2022 01:48:59 PM Central Daylight Time			08/04/2022 10:00:23 PM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Select (HMO)	01	01		1			H6529	001	2	2023	Indiana (Partial)	Anderson, Evansville, Indianapolis	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		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		2					2					2	2			
H6529	002	0	1	01	01	H6529_002_0	8	1					1	08/04/2022	2023.01	08/04/2022 06:07:20 PM Central Daylight Time	08/04/2022 05:02:06 PM Central Daylight Time	08/04/2022 01:49:53 PM Central Daylight Time			08/04/2022 10:00:23 PM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Select Plus (HMO)	01	01		1			H6529	002	0	2023	Evansville IN		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		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		2					2					2	2			
H6541	001	0	1	20	08	H6541_001_0	1	1						06/02/2022	2023.01	06/02/2022 09:31:38 AM Eastern Daylight Time		05/27/2022 03:06:42 PM Eastern Daylight Time			06/02/2022 09:35:22 AM Eastern Daylight Time	HORIZON-PACE, LLC	Horizon - PACE	www.forhorizon.com	Horizon PACE - Dual Eligible (PACE)	08	20		1			H6541	001	0	2023	Counties: BA,CL,ES, JA, LA, MA, MC, PU, RO, WR, WA		2		2			2									n/a	n/a										(877)589-3053		(859)623-4080		(877)589-3053		(859)623-4080												(859)623-4080				(859)623-4080																
H6541	002	0	1	20	08	H6541_002_0	1	1						06/02/2022	2023.01	06/02/2022 09:32:26 AM Eastern Daylight Time		05/27/2022 03:09:29 PM Eastern Daylight Time			06/02/2022 09:35:22 AM Eastern Daylight Time	HORIZON-PACE, LLC	Horizon - PACE	www.forhorizon.com	Horizon PACE - Medicare Only (PACE)	08	20		1			H6541	002	0	2023	Counties: BA,CL,ES, JA, LA, MA, MC, PU, RO, WR, WA		2		2			2									n/a	n/a										(877)589-3053		(859)623-4080		(877)589-3053		(859)623-4080												(859)623-4080				(859)623-4080																
H6545	001	0	1	04	01	H6545_001_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:13:27 PM US Eastern Daylight Time	08/04/2022 09:46:55 AM Eastern Daylight Time	07/31/2022 01:52:04 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Devoted Health	www.Devoted.com	Devoted CHOICE Illinois (PPO)	01	04		1			H6545	001	0	2023	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			
H6550	003	0	1	01	01	H6550_003_0	4	1						08/01/2022	2023.01	08/01/2022 12:58:55 PM Eastern Daylight Time	08/03/2022 08:01:16 PM Eastern Daylight Time	07/30/2022 10:00:59 AM Eastern Daylight Time			08/04/2022 06:10:56 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	2023	Select counties in KS		2		2			2									www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	004	0	1	01	01	H6550_004_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 10:49:39 AM Eastern Daylight Time	08/03/2022 08:02:31 PM Eastern Daylight Time	07/30/2022 10:01:32 AM Eastern Daylight Time			08/04/2022 06:10:56 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	2023	Select counties in KS		2		2			1	3		1					1	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(833)402-6707		(833)402-6707		(844)917-0175		(844)917-0175		(833)402-6707		(833)402-6707		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	006	0	1	01	01	H6550_006_0	4	1						05/28/2022	2023.01	05/28/2022 10:10:09 PM Eastern Daylight Time	08/03/2022 08:03:42 PM Eastern Daylight Time	07/30/2022 10:02:04 AM Eastern Daylight Time			08/04/2022 06:10:56 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	2023	Select counties in KS		2		2			2									www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	007	0	1	01	01	H6550_007_0	4	1						08/01/2022	2023.01	08/01/2022 02:24:33 PM Eastern Daylight Time	08/03/2022 08:04:55 PM Eastern Daylight Time	07/30/2022 10:02:36 AM Eastern Daylight Time			08/04/2022 06:10:56 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	2023	Select counties in KS		2		2			2									www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	009	0	1	01	01	H6550_009_0	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 10:51:40 AM Eastern Daylight Time	08/03/2022 08:06:06 PM Eastern Daylight Time	07/30/2022 10:03:08 AM Eastern Daylight Time			08/04/2022 06:10:56 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	2023	Select counties in KS		2		2			1	3		1					1	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(833)402-6707		(833)402-6707		(844)917-0175		(844)917-0175		(833)402-6707		(833)402-6707		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	801	0	1	01	01	H6550_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:18:44 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	01	01		1			H6550	801	0	2023	Kansas		1	100	2			2									allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:18:51 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	01	01		1			H6550	802	0	2023	Kansas		1	100	2			2									allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:18:56 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	01	01		1			H6550	803	0	2023	Kansas		1	100	2			2									allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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						05/26/2022	2023.01	05/26/2022 03:15:21 PM Eastern Daylight Time		05/26/2022 02:02:25 PM Eastern Daylight Time			05/26/2022 03:18:14 PM Eastern Daylight Time	LIFE ST. MARY	LIFE St. Mary	trinityhealthpace.org	LIFE St. Mary (PACE)	08	20		1			H6551	001	0	2023	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						05/26/2022	2023.01	05/26/2022 03:15:53 PM Eastern Daylight Time		05/26/2022 02:03:32 PM Eastern Daylight Time			05/26/2022 03:18:14 PM Eastern Daylight Time	LIFE ST. MARY	LIFE St. Mary	trinityhealthpace.org	LIFE St. Mary (PACE)	08	20		1			H6551	002	0	2023	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																
H6586	001	0	1	04	01	H6586_001_0	9	1					1	08/04/2022	2023.01	08/04/2022 11:23:45 PM US Eastern Daylight Time	08/04/2022 09:47:21 AM Eastern Daylight Time	07/31/2022 01:52:26 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted CHOICE Arizona (PPO)	01	04		1			H6586	001	0	2023	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			
H6586	002	0	1	04	01	H6586_002_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:14:35 PM US Eastern Daylight Time	08/04/2022 09:47:48 AM Eastern Daylight Time	07/31/2022 01:52:47 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted CHOICE Arizona (PPO)	01	04		1			H6586	002	0	2023	Yavapai and Coconino 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			
H6586	003	0	1	04	01	H6586_003_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:15:18 PM US Eastern Daylight Time	08/04/2022 09:49:50 AM Eastern Daylight Time	07/31/2022 01:53:09 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted CHOICE Arizona (PPO)	01	04		1			H6586	003	0	2023	Pima 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			
H6594	001	0	1	04	01	H6594_001_0	4	1						08/03/2022	2023.01	08/03/2022 02:28:10 PM Eastern Daylight Time	08/03/2022 07:19:05 PM Central Daylight Time	07/30/2022 09:03:39 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H6594	001	0	2023	Select counties in VT		2		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	4	1						08/02/2022	2023.01	08/02/2022 09:52:45 AM Eastern Daylight Time	08/03/2022 07:20:18 PM Central Daylight Time	07/30/2022 09:04:11 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H6594	002	0	2023	Select counties in VT		2		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	4	1						06/01/2022	2023.01	06/01/2022 05:47:31 PM Eastern Daylight Time	08/03/2022 07:21:30 PM Central Daylight Time	07/30/2022 09:04:43 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Plus Open (PPO)	01	04		1			H6594	003	0	2023	Select counties in VT		2		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	4	1						07/14/2022	2023.01	07/14/2022 09:44:43 AM Central Daylight Time	08/03/2022 07:22:40 PM Central Daylight Time	07/30/2022 09:05:15 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H6594	004	0	2023	Select counties in VT		2		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	003	0	1	02	01	H6595_003_0	2	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 10:36:40 AM Central Daylight Time	08/03/2022 11:35:49 AM Central Daylight Time	07/31/2022 03:37:04 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H6595	003	0	2023	Select counties of Kentucky		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			
H6595	004	0	1	02	01	H6595_004_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 12:05:00 PM Central Daylight Time	08/03/2022 11:36:29 AM Central Daylight Time	07/31/2022 03:37:29 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H6595	004	0	2023	Select counties in Kentucky		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			
H6596	001	0	1	20	08	H6596_001_0	1	1						05/06/2022	2023.01	05/06/2022 09:01:12 AM Eastern Daylight Time		06/01/2022 12:39:10 PM Eastern Daylight Time			06/01/2022 02:18:40 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	2023	Erie County		2		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						05/06/2022	2023.01	05/06/2022 09:01:55 AM Eastern Daylight Time		06/01/2022 12:39:12 PM Eastern Daylight Time			06/01/2022 02:18:40 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	2023	Erie County		2		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						08/03/2022	2023.01	08/03/2022 03:38:22 PM Eastern Daylight Time	08/03/2022 08:36:13 PM Eastern Daylight Time	07/30/2022 10:05:46 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Wellcare	www.wellcare.com/ohana	Wellcare 'Ohana No Premium Open (PPO)	01	04		1			H6605	001	0	2023	Select counties in HI		2		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	05/29/2022	2023.01	05/29/2022 01:44:41 PM Eastern Daylight Time	06/03/2022 09:04:13 PM Eastern Daylight Time				07/15/2022 03:48:23 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Wellcare	www.wellcare.com/ohana	Wellcare 'Ohana Patriot Giveback Open (PPO)	01	04		1			H6605	002	0	2023	Select counties in HI		2		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						05/29/2022	2023.01	05/29/2022 01:45:38 PM Eastern Daylight Time	08/03/2022 08:37:22 PM Eastern Daylight Time	07/30/2022 10:06:19 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Wellcare	www.wellcare.com/ohana	Wellcare 'Ohana Assist Open (PPO)	01	04		1			H6605	003	0	2023	Select counties in HI		2		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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:25:27 PM Eastern Daylight Time	08/03/2022 03:48:28 PM Eastern Daylight Time	07/30/2022 09:21:38 AM Eastern Daylight Time			08/04/2022 11:14:32 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-001 (HMO)	01	01		1			H6622	001	0	2023	Green Bay area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/02/2022	2023.01	08/02/2022 01:35:57 PM Eastern Daylight Time	08/03/2022 04:03:56 PM Eastern Daylight Time	07/30/2022 09:22:04 AM Eastern Daylight Time			08/04/2022 04:38:40 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	2023	Richmond		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 03:29:59 PM Eastern Daylight Time	08/03/2022 04:04:25 PM Eastern Daylight Time	07/30/2022 09:22:30 AM Eastern Daylight Time			08/04/2022 04:38:40 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	2023	Tidewater		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			1		1	06/02/2022	2023.01	06/02/2022 11:38:56 AM Eastern Daylight Time	08/03/2022 03:46:52 PM Eastern Daylight Time	07/30/2022 09:22:54 AM Eastern Daylight Time			08/04/2022 12:37:53 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	2023	Select Counties in MT		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 09:21:55 AM Eastern Daylight Time	08/03/2022 03:47:47 PM Eastern Daylight Time	07/30/2022 09:23:20 AM Eastern Daylight Time			08/04/2022 12:44:49 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	2023	Select Counties in MT		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_010_0	4	1			1		1	08/02/2022	2023.01	08/02/2022 01:44:38 PM Eastern Daylight Time	08/03/2022 04:06:19 PM Eastern Daylight Time	07/30/2022 09:23:46 AM Eastern Daylight Time			08/04/2022 04:38:40 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-010 (HMO-POS)	01	02		1			H6622	010	0	2023	Delaware		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_013_0	5	1			1		1	08/01/2022	2023.01	08/01/2022 12:41:48 PM Eastern Daylight Time	08/03/2022 04:24:59 PM Eastern Daylight Time	07/30/2022 09:24:12 AM Eastern Daylight Time			08/04/2022 12:28:27 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-013 (HMO-POS)	01	02		1			H6622	013	0	2023	Columbus Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_014_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 12:42:30 PM Eastern Daylight Time	08/03/2022 04:25:28 PM Eastern Daylight Time	07/30/2022 09:24:36 AM Eastern Daylight Time			08/04/2022 12:28:27 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-014 (HMO-POS)	01	02		1			H6622	014	0	2023	Canton-Akron Metro Areas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 12:42:59 PM Eastern Daylight Time	08/03/2022 04:25:57 PM Eastern Daylight Time	07/30/2022 09:25:02 AM Eastern Daylight Time			08/04/2022 12:28:27 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	2023	Select counties in Ohio		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 12:43:15 PM Eastern Daylight Time	08/03/2022 04:27:24 PM Eastern Daylight Time	07/30/2022 09:25:26 AM Eastern Daylight Time			08/04/2022 12:28:27 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	2023	Ohio & N KY		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 12:43:32 PM Eastern Daylight Time	08/03/2022 04:28:20 PM Eastern Daylight Time	07/30/2022 09:25:52 AM Eastern Daylight Time			08/04/2022 12:28:27 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	2023	Northern Kentucky Area		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/28/2022	2023.01	05/28/2022 09:30:02 AM Eastern Daylight Time	08/03/2022 04:32:08 PM Eastern Daylight Time	07/30/2022 09:26:16 AM Eastern Daylight Time			08/04/2022 12:28:27 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	2023	Ohio & N KY		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_021_1	4	1			1		1	08/01/2022	2023.01	08/01/2022 12:43:50 PM Eastern Daylight Time	08/03/2022 04:30:43 PM Eastern Daylight Time	07/30/2022 09:26:42 AM Eastern Daylight Time			08/04/2022 12:28:27 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-021 (HMO-POS)	01	02		1			H6622	021	1	2023	Select KY counties in Cincinnati Metro Area	Select KY counties in Cincinnati Metro Area	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_021_2	5	1			1		1	08/01/2022	2023.01	08/01/2022 12:44:22 PM Eastern Daylight Time	08/03/2022 04:31:11 PM Eastern Daylight Time	07/30/2022 09:27:08 AM Eastern Daylight Time			08/04/2022 12:28:27 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-021 (HMO-POS)	01	02		1			H6622	021	2	2023	Select KY counties in Cincinnati Metro Area	Cincinnati/Dayton	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_022_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 12:44:58 PM Eastern Daylight Time	08/03/2022 04:34:03 PM Eastern Daylight Time	07/30/2022 09:27:34 AM Eastern Daylight Time			08/04/2022 12:28:27 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-022 (HMO-POS)	01	02		1			H6622	022	0	2023	Cleveland/Toledo		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_023_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 12:45:30 PM Eastern Daylight Time	08/03/2022 04:36:24 PM Eastern Daylight Time	07/30/2022 09:28:00 AM Eastern Daylight Time			08/04/2022 12:28:27 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Cleveland Clinic Preferred (HMO-POS)	01	02		1			H6622	023	0	2023	Select counties in Ohio		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 03:27:38 PM Eastern Daylight Time	08/03/2022 04:08:13 PM Eastern Daylight Time	07/30/2022 09:28:24 AM Eastern Daylight Time			08/04/2022 02:59:41 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	2023	Western North Carolina Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:28:08 PM Eastern Daylight Time	08/03/2022 04:06:47 PM Eastern Daylight Time	07/30/2022 09:28:50 AM Eastern Daylight Time			08/04/2022 02:59:41 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	2023	Western North Carolina Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_027_0	3	1	2	1	1		0	05/30/2022	2023.01	05/30/2022 02:03:21 PM Eastern Daylight Time	08/03/2022 04:07:16 PM Eastern Daylight Time	07/30/2022 09:29:16 AM Eastern Daylight Time			08/04/2022 03:11:05 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-027 (HMO-POS D-SNP)	01	02		1			H6622	027	0	2023	Western North Carolina Area		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 08:20:28 AM Eastern Daylight Time	08/03/2022 04:05:52 PM Eastern Daylight Time	07/30/2022 09:29:42 AM Eastern Daylight Time			08/04/2022 01:17:04 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	2023	Clark and Nye Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 08:22:17 AM Eastern Daylight Time	08/03/2022 04:04:51 PM Eastern Daylight Time	07/30/2022 09:30:08 AM Eastern Daylight Time			08/04/2022 01:17:04 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	2023	Clark and Nye Counties		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1		1	1		1	08/01/2022	2023.01	08/01/2022 08:23:08 AM Eastern Daylight Time	08/03/2022 04:05:21 PM Eastern Daylight Time	07/30/2022 09:30:34 AM Eastern Daylight Time			08/04/2022 01:17:04 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	2023	Clark and Nye Counties		2		2			1	4			00000000000100000000000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	032	0	1	01	01	H6622_032_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:38:20 PM Eastern Daylight Time	08/03/2022 03:46:21 PM Eastern Daylight Time	07/30/2022 09:30:58 AM Eastern Daylight Time			08/04/2022 10:57:40 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-032 (HMO)	01	01		1			H6622	032	0	2023	Select Counties in Oklahoma		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	033	0	1	01	01	H6622_033_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:38:30 PM Eastern Daylight Time	08/03/2022 03:46:53 PM Eastern Daylight Time	07/30/2022 09:31:24 AM Eastern Daylight Time			08/04/2022 10:57:40 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-033 (HMO)	01	01		1			H6622	033	0	2023	Select Counties in Oklahoma		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:25:52 PM Eastern Daylight Time	08/03/2022 03:58:45 PM Eastern Daylight Time	07/30/2022 09:31:48 AM Eastern Daylight Time			08/04/2022 11:14:32 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-034 (HMO)	01	01		1			H6622	034	0	2023	Milwaukee area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	035	0	1	01	01	H6622_035_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 01:23:19 PM Eastern Daylight Time	08/03/2022 04:34:21 PM Eastern Daylight Time	07/30/2022 09:32:14 AM Eastern Daylight Time			08/04/2022 05:19:22 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	2023	Central-Western Pennsylvania area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:24:21 PM Eastern Daylight Time	08/03/2022 04:35:06 PM Eastern Daylight Time	07/30/2022 09:32:40 AM Eastern Daylight Time			08/04/2022 05:19:22 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	2023	Northeast Pennsylvania Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:25:25 PM Eastern Daylight Time	08/03/2022 04:35:50 PM Eastern Daylight Time	07/30/2022 09:33:06 AM Eastern Daylight Time			08/04/2022 05:19:22 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	2023	Greater Philadelphia Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:11:43 PM Eastern Daylight Time	08/03/2022 03:56:59 PM Eastern Daylight Time	07/30/2022 09:33:30 AM Eastern Daylight Time			08/04/2022 02:49:26 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	2023	Select Counties in Mississippi		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 06:54:15 PM Eastern Daylight Time	08/03/2022 03:56:30 PM Eastern Daylight Time	07/30/2022 09:33:56 AM Eastern Daylight Time			08/04/2022 02:49:26 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	2023	Select Counties in Mississippi		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	049	0	1	01	01	H6622_049_0	3	1			1		0	07/14/2022	2023.01	07/14/2022 10:48:34 AM Eastern Daylight Time	08/03/2022 03:48:55 PM Eastern Daylight Time	07/30/2022 09:34:22 AM Eastern Daylight Time			08/04/2022 10:57:40 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Value Plus H6622-049 (HMO)	01	01		1			H6622	049	0	2023	Select Counties in Oklahoma		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/02/2022	2023.01	08/02/2022 12:21:53 PM Eastern Daylight Time	08/03/2022 04:10:42 PM Eastern Daylight Time	07/30/2022 09:34:48 AM Eastern Daylight Time			08/04/2022 04:38:40 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	2023	Delaware		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:26:29 PM Eastern Daylight Time	08/03/2022 04:46:44 PM Eastern Daylight Time	07/30/2022 09:35:14 AM Eastern Daylight Time			08/04/2022 05:19:22 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	2023	Guthrie and Susquehanna Valley HMO		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:27:35 PM Eastern Daylight Time	08/03/2022 04:45:10 PM Eastern Daylight Time	07/30/2022 09:35:38 AM Eastern Daylight Time			08/04/2022 05:19:22 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	2023	Greater Pittsburgh Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	055	0	1	01	01	H6622_055_0	4	1			1		1	05/29/2022	2023.01	05/29/2022 11:11:35 AM Eastern Daylight Time	08/03/2022 04:40:13 PM Eastern Daylight Time	07/30/2022 09:36:04 AM Eastern Daylight Time			08/04/2022 12:28:27 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	2023	Select counties in Ohio		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 08:24:19 AM Eastern Daylight Time	08/03/2022 04:12:48 PM Eastern Daylight Time	07/30/2022 09:36:30 AM Eastern Daylight Time			08/04/2022 01:17:04 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	2023	Clark and Nye Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_057_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:30:22 PM Eastern Daylight Time	08/03/2022 04:12:57 PM Eastern Daylight Time	07/30/2022 09:36:54 AM Eastern Daylight Time			08/04/2022 02:59:41 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-057 (HMO-POS)	01	02		1			H6622	057	0	2023	Charlotte Metro Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 04:11:56 PM Eastern Daylight Time	08/03/2022 04:00:14 PM Eastern Daylight Time	07/30/2022 09:37:20 AM Eastern Daylight Time			08/04/2022 02:49:26 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	2023	Select Counties in Mississippi		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_060_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 03:30:47 PM Eastern Daylight Time	08/03/2022 04:13:57 PM Eastern Daylight Time	07/30/2022 09:37:46 AM Eastern Daylight Time			08/04/2022 02:59:41 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-060 (HMO-POS)	01	02		1			H6622	060	0	2023	Triangle Perimeter		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_061_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 03:31:07 PM Eastern Daylight Time	08/03/2022 04:14:27 PM Eastern Daylight Time	07/30/2022 09:38:10 AM Eastern Daylight Time			08/04/2022 02:59:41 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-061 (HMO-POS)	01	02		1			H6622	061	0	2023	Wilmington		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	05/28/2022	2023.01	05/28/2022 11:00:37 AM Eastern Daylight Time	08/03/2022 04:06:40 PM Eastern Daylight Time	07/30/2022 09:38:36 AM Eastern Daylight Time			08/04/2022 11:31:07 AM 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	2023	Select Counties in Minnesota		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:22:36 AM Eastern Daylight Time	08/03/2022 03:46:09 PM Eastern Daylight Time	07/30/2022 09:39:02 AM Eastern Daylight Time			08/04/2022 03:23:03 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	2023	Select Counties in New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:28:31 PM Eastern Daylight Time	08/03/2022 04:54:15 PM Eastern Daylight Time	07/30/2022 09:39:26 AM Eastern Daylight Time			08/04/2022 05:19:22 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	2023	Southern New Jersey		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1	1		1	08/01/2022	2023.01	08/01/2022 12:38:40 PM Eastern Daylight Time	08/03/2022 04:00:15 PM Eastern Daylight Time	07/30/2022 09:39:52 AM Eastern Daylight Time			08/04/2022 10:57:40 AM 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	2023	Select Counties in Oklahoma		2		2			1	4			00000000000000000010000					https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/02/2022	2023.01	08/02/2022 01:16:22 PM Eastern Daylight Time	08/03/2022 04:09:49 PM Eastern Daylight Time	07/30/2022 09:40:18 AM Eastern Daylight Time			08/04/2022 11:31:07 AM 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	2023	Select Counties in Minnesota		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 10:29:23 AM Eastern Daylight Time	08/03/2022 04:19:51 PM Eastern Daylight Time	07/30/2022 09:40:42 AM Eastern Daylight Time			08/04/2022 04:38:40 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	2023	Virginia	Virginia	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 10:30:03 AM Eastern Daylight Time	08/03/2022 04:20:21 PM Eastern Daylight Time	07/30/2022 09:41:08 AM Eastern Daylight Time			08/04/2022 04:38:40 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	2023	Virginia	Richmond Tidewater	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 08:26:44 AM Eastern Daylight Time	08/03/2022 04:21:13 PM Eastern Daylight Time	07/30/2022 09:41:34 AM Eastern Daylight Time			08/04/2022 01:17:04 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	2023	Carson City and Washoe counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_076_0	3	1		1	1		1	08/01/2022	2023.01	08/01/2022 04:26:42 PM Eastern Daylight Time	08/03/2022 04:17:31 PM Eastern Daylight Time	07/30/2022 09:42:00 AM Eastern Daylight Time			08/04/2022 11:14:32 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Together in Health (HMO-POS I-SNP)	01	02		1			H6622	076	0	2023	Select Counties in Wisconsin		2		2			1	1	1							https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_077_0	3	1		1	1		1	08/02/2022	2023.01	08/02/2022 12:00:50 PM Eastern Daylight Time	08/03/2022 04:18:33 PM Eastern Daylight Time	07/30/2022 09:42:24 AM Eastern Daylight Time			08/04/2022 11:14:32 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Senior Living Plan (HMO-POS I-SNP)	01	02		1			H6622	077	0	2023	Select Counties in Wisconsin		2		2			1	1	2							https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1	2	1	1		0	07/15/2022	2023.01	07/15/2022 09:15:06 AM Eastern Daylight Time	08/03/2022 04:56:31 PM Eastern Daylight Time	07/30/2022 09:42:50 AM Eastern Daylight Time			08/04/2022 05:19:22 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	2023	Pennsylvania	Select counties in Pennsylvania	2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 01:11:34 PM Eastern Daylight Time	08/03/2022 04:57:17 PM Eastern Daylight Time	07/30/2022 09:43:16 AM Eastern Daylight Time			08/04/2022 05:19:22 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	2023	Pennsylvania	Greater Philadelphia	2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/21/2022	2023.01	07/21/2022 11:02:55 AM Eastern Daylight Time	08/03/2022 04:21:43 PM Eastern Daylight Time	07/30/2022 09:43:42 AM Eastern Daylight Time			08/04/2022 01:52:45 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	2023	Select Counties in Nevada		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	081	0	1	01	01	H6622_081_0	4	1			1		1	05/29/2022	2023.01	05/29/2022 10:30:37 AM Eastern Daylight Time	08/03/2022 04:21:05 PM Eastern Daylight Time	07/30/2022 09:44:32 AM Eastern Daylight Time			08/04/2022 04:38:40 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-081 (HMO)	01	01		1			H6622	081	0	2023	Greater Baltimore		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	082	0	1	01	01	H6622_082_0	4	1			1		1	08/01/2022	2023.01	08/01/2022 09:06:26 AM Eastern Daylight Time	08/03/2022 04:27:07 PM Eastern Daylight Time	07/30/2022 09:44:58 AM Eastern Daylight Time			08/04/2022 02:15:54 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-082 (HMO)	01	01		1			H6622	082	0	2023	Clark and Nye Counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/27/2022	2023.01	05/27/2022 06:31:35 PM Eastern Daylight Time					06/03/2022 03:41:22 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	801	0	2023	Select counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 06:33:01 PM Eastern Daylight Time					06/03/2022 03:41:22 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	802	0	2023	Select counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1						05/27/2022	2023.01	05/27/2022 06:35:22 PM Eastern Daylight Time					06/03/2022 03:41:22 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	804	0	2023	Select counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 06:37:28 PM Eastern Daylight Time					06/03/2022 03:41:22 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	805	0	2023	Select counties in Multi States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	5	1		1				08/02/2022	2023.01	08/02/2022 12:09:09 PM Central Daylight Time	08/01/2022 11:04:43 PM Central Daylight Time	07/29/2022 05:33:34 PM Central Daylight Time			08/03/2022 09:32:37 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	2023	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	1	01	7c;7i;	
H6672	001	0	1	01	01	H6672_001_0	5	1	2	1			0	08/03/2022	2023.01	08/03/2022 07:57:18 AM Central Daylight Time	08/04/2022 03:18:13 PM Central Daylight Time	08/04/2022 03:38:33 PM Central Daylight Time			08/04/2022 04:25:51 PM Central Daylight Time	CLEAR SPRING HEALTH (GA), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Deluxe Plan (HMO D-SNP)	01	01		1			H6672	001	0	2023	Select Georgia Counties		2		2			1	3		1					1	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			
H6672	003	0	1	01	01	H6672_003_0	5	1		1			1	08/03/2022	2023.01	08/03/2022 07:58:10 AM Central Daylight Time	08/04/2022 03:19:31 PM Central Daylight Time	08/04/2022 03:38:55 PM Central Daylight Time			08/04/2022 04:25:51 PM Central Daylight Time	CLEAR SPRING HEALTH (GA), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Silver Plan (HMO C-SNP)	01	01		1			H6672	003	0	2023	Select Georgia Counties		2		2			1	4			00000000000000000010000					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			
H6672	005	0	1	01	01	H6672_005_0	5	1					1	08/03/2022	2023.01	08/03/2022 07:59:04 AM Central Daylight Time	08/04/2022 03:20:30 PM Central Daylight Time	08/04/2022 03:39:15 PM Central Daylight Time			08/04/2022 04:25:51 PM Central Daylight Time	CLEAR SPRING HEALTH (GA), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Select Plus (HMO)	01	01		1			H6672	005	0	2023	Select Georgia 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	2			
H6678	001	0	1	01	01	H6678_001_0	5	1						08/01/2022	2023.01	08/01/2022 12:47:25 PM Central Daylight Time	08/03/2022 08:47:27 PM Eastern Daylight Time	07/30/2022 10:06:57 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Seton Reward (HMO)	01	01		1			H6678	001	0	2023	Austin Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6678	002	0	1	01	01	H6678_002_0	5	1						08/01/2022	2023.01	08/01/2022 12:48:12 PM Central Daylight Time	08/03/2022 08:48:42 PM Eastern Daylight Time	07/30/2022 10:07:32 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Seton Secure (HMO)	01	01		1			H6678	002	0	2023	Austin Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6678	003	0	1	01	01	H6678_003_0	5	1						08/01/2022	2023.01	08/01/2022 12:49:44 PM Central Daylight Time	08/03/2022 08:49:57 PM Eastern Daylight Time	07/30/2022 10:08:04 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Providence Reward (HMO)	01	01		1			H6678	003	0	2023	Waco Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6678	004	0	1	01	01	H6678_004_0	5	1						08/01/2022	2023.01	08/01/2022 12:50:37 PM Central Daylight Time	08/03/2022 08:51:11 PM Eastern Daylight Time	07/30/2022 10:08:36 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Providence Secure (HMO)	01	01		1			H6678	004	0	2023	Waco Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6706	001	0	1	02	01	H6706_001_0	2	1					1	08/02/2022	2023.01	08/02/2022 10:25:09 AM Central Daylight Time	08/03/2022 12:07:21 PM Central Daylight Time	07/31/2022 03:37:54 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	UnitedHealthcare Benefits of Texas, Inc.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H6706	001	0	2023	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						08/01/2022	2023.01	08/01/2022 12:36:21 PM Eastern Daylight Time	08/03/2022 08:08:27 PM Eastern Daylight Time	07/30/2022 10:09:08 AM Eastern Daylight Time			08/04/2022 06:08:31 PM Eastern Daylight Time	WELLCARE OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H6713	001	0	2023	Select counties in IL		2		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						08/03/2022	2023.01	08/03/2022 02:29:20 PM Eastern Daylight Time	08/03/2022 08:09:37 PM Eastern Daylight Time	07/30/2022 10:09:39 AM Eastern Daylight Time			08/04/2022 06:08:31 PM Eastern Daylight Time	WELLCARE OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H6713	002	0	2023	Select counties in IL		2		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	14	1						08/04/2022	2023.01	08/04/2022 03:57:11 PM Eastern Daylight Time	08/03/2022 12:23:00 PM Eastern Daylight Time	08/02/2022 03:20:56 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	1	2023	Ohio Regions	Northeast Ohio	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	001	2	1	01	01	H6723_001_2	14	1						08/04/2022	2023.01	08/04/2022 11:32:39 AM Eastern Daylight Time	08/03/2022 12:23:46 PM Eastern Daylight Time	08/02/2022 03:21:22 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	2	2023	Ohio Regions	Select Ohio Counties	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	001	3	1	01	01	H6723_001_3	15	1						08/04/2022	2023.01	08/04/2022 03:57:49 PM Eastern Daylight Time	08/03/2022 12:24:28 PM Eastern Daylight Time	08/02/2022 03:21:48 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	3	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	1	1	01	01	H6723_002_1	14	1						08/04/2022	2023.01	08/04/2022 11:34:57 AM Eastern Daylight Time	08/03/2022 12:25:12 PM Eastern Daylight Time	08/02/2022 03:22:14 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	1	2023	Ohio Regions	Northeast Ohio	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	2	1	01	01	H6723_002_2	14	1						08/04/2022	2023.01	08/04/2022 11:35:57 AM Eastern Daylight Time	08/03/2022 12:25:56 PM Eastern Daylight Time	08/02/2022 03:22:40 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	2	2023	Ohio Regions	Select Ohio Counties	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	3	1	01	01	H6723_002_3	14	1						08/04/2022	2023.01	08/04/2022 11:37:28 AM Eastern Daylight Time	08/03/2022 12:26:40 PM Eastern Daylight Time	08/02/2022 03:23:06 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	3	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	003	1	1	01	01	H6723_003_1	15	1						08/04/2022	2023.01	08/04/2022 11:38:45 AM Eastern Daylight Time	08/03/2022 12:27:32 PM Eastern Daylight Time	08/02/2022 03:23:30 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Plus (HMO)	01	01		1			H6723	003	1	2023	Ohio Regions	Northeast Ohio	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	003	2	1	01	01	H6723_003_2	14	1						08/04/2022	2023.01	08/04/2022 11:39:25 AM Eastern Daylight Time	08/03/2022 12:28:22 PM Eastern Daylight Time	08/02/2022 03:23:56 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Plus (HMO)	01	01		1			H6723	003	2	2023	Ohio Regions	Select Ohio Counties	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	003	3	1	01	01	H6723_003_3	15	1						08/04/2022	2023.01	08/04/2022 11:39:56 AM Eastern Daylight Time	08/03/2022 12:29:06 PM Eastern Daylight Time	08/02/2022 03:24:22 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Plus (HMO)	01	01		1			H6723	003	3	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	005	1	1	01	01	H6723_005_1	15	1						08/05/2022	2023.01	08/05/2022 11:43:33 AM Eastern Daylight Time	08/03/2022 12:29:48 PM Eastern Daylight Time	08/02/2022 03:24:46 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Secure (HMO)	01	01		1			H6723	005	1	2023	Ohio Regions	Northeast Ohio	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	005	2	1	01	01	H6723_005_2	15	1						08/05/2022	2023.01	08/05/2022 11:44:17 AM Eastern Daylight Time	08/03/2022 12:30:30 PM Eastern Daylight Time	08/02/2022 03:25:12 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Secure (HMO)	01	01		1			H6723	005	2	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	006	1	1	01	01	H6723_006_1	14	1						08/04/2022	2023.01	08/04/2022 03:58:49 PM Eastern Daylight Time	08/03/2022 12:31:14 PM Eastern Daylight Time	08/02/2022 03:25:38 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Signature (HMO)	01	01		1			H6723	006	1	2023	Ohio Regions	Northeast Ohio	2		2			2									medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	006	2	1	01	01	H6723_006_2	14	1						08/04/2022	2023.01	08/04/2022 03:59:08 PM Eastern Daylight Time	08/03/2022 12:32:08 PM Eastern Daylight Time	08/02/2022 03:26:04 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Signature (HMO)	01	01		1			H6723	006	2	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	006	3	1	01	01	H6723_006_3	14	1						08/04/2022	2023.01	08/04/2022 04:05:38 PM Eastern Daylight Time	08/03/2022 12:32:58 PM Eastern Daylight Time	08/02/2022 03:26:28 PM Eastern Daylight Time			08/05/2022 06:46:00 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Signature (HMO)	01	01		1			H6723	006	3	2023	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)264-4956		(877)264-4956		(800)982-3117		(800)982-3117		(877)264-4956		(877)264-4956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	801	0	1	01	01	H6723_801_0	7	1						05/10/2022	2023.01	05/10/2022 10:58:49 AM Eastern Daylight Time					06/06/2022 10:46:55 AM 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	2023	Ohio Regions		1	6000	2			2									medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;6;8a;8b1;9a1;9b;10a;11a;11b;15;	2		1					2				
H6723	802	0	1	01	01	H6723_802_0	7	1						05/10/2022	2023.01	05/10/2022 11:01:57 AM Eastern Daylight Time					06/06/2022 10:46:55 AM 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	2023	Ohio Regions		1	100	2			2									medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823		(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	7	1				0	0	05/10/2022	2023.01	05/10/2022 11:07:36 AM Eastern Daylight Time					06/06/2022 10:46:55 AM 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	2023	Ohio Regions		1	100	2			2									medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(800)801-4823		(800)801-4823		(800)801-4823		(800)801-4823										(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						08/04/2022	2023.01	08/04/2022 10:13:01 AM Pacific Daylight Time	08/03/2022 02:41:02 PM Pacific Daylight Time	08/01/2022 10:53:46 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H6743	001	0	2023	Klamath County		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			
H6743	007	0	1	04	01	H6743_007_0	5	1						08/04/2022	2023.01	08/04/2022 10:15:55 AM Pacific Daylight Time	08/03/2022 02:41:32 PM Pacific Daylight Time	08/01/2022 10:54:18 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H6743	007	0	2023	Douglas County		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			
H6743	023	1	1	04	01	H6743_023_1	5	1						08/04/2022	2023.01	08/04/2022 10:16:03 AM Pacific Daylight Time	08/03/2022 02:42:01 PM Pacific Daylight Time	08/01/2022 10:54:51 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Prime Rx (PPO)	01	04		1			H6743	023	1	2023	Oregon	Douglas	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			
H6743	023	2	1	04	01	H6743_023_2	5	1						08/04/2022	2023.01	08/04/2022 10:16:17 AM Pacific Daylight Time	08/03/2022 02:42:29 PM Pacific Daylight Time	08/01/2022 10:55:25 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Prime Rx (PPO)	01	04		1			H6743	023	2	2023	Oregon	Jackson/Josephine	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			
H6743	023	3	1	04	01	H6743_023_3	5	1						08/04/2022	2023.01	08/04/2022 10:16:26 AM Pacific Daylight Time	08/03/2022 02:42:58 PM Pacific Daylight Time	08/01/2022 10:55:59 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Prime Rx (PPO)	01	04		1			H6743	023	3	2023	Oregon	Klamath	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			
H6743	024	1	1	04	01	H6743_024_1	4	1				0	0	07/01/2022	2023.01	07/01/2022 10:16:18 AM US Mountain Standard Time	06/06/2022 11:45:27 AM Pacific Daylight Time				07/05/2022 09:42:12 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Freedom (PPO)	01	04		1			H6743	024	1	2023	Oregon	Douglas	2		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	024	2	1	04	01	H6743_024_2	4	1				0	0	07/01/2022	2023.01	07/01/2022 10:16:29 AM US Mountain Standard Time	06/06/2022 11:45:58 AM Pacific Daylight Time				07/05/2022 09:42:12 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Freedom (PPO)	01	04		1			H6743	024	2	2023	Oregon	Jackson/Josephine	2		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	024	3	1	04	01	H6743_024_3	4	1				0	0	07/01/2022	2023.01	07/01/2022 10:16:40 AM US Mountain Standard Time	06/06/2022 11:46:30 AM Pacific Daylight Time				07/05/2022 09:42:12 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Freedom (PPO)	01	04		1			H6743	024	3	2023	Oregon	Klamath	2		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	025	0	1	04	01	H6743_025_0	5	1						08/04/2022	2023.01	08/04/2022 10:17:07 AM Pacific Daylight Time	08/03/2022 02:44:54 PM Pacific Daylight Time	08/01/2022 10:56:31 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H6743	025	0	2023	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			
H6750	005	0	1	01	01	H6750_005_0	5	1					1	08/02/2022	2023.01	08/02/2022 03:49:48 PM Eastern Daylight Time	08/03/2022 02:04:50 PM Eastern Daylight Time	08/02/2022 02:21:16 PM Eastern Daylight Time			08/05/2022 12:05:01 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	2023	Most of New Hampshire		2		2			2									www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	012	1	1	01	01	H6750_012_1	5	1					1	06/06/2022	2023.01	06/06/2022 09:35:32 PM Eastern Daylight Time	08/03/2022 02:05:14 PM Eastern Daylight Time	08/02/2022 02:21:36 PM Eastern Daylight Time			08/05/2022 12:05:01 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	2023	New Hampshire	Strafford County NH	2		2			2									www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	012	2	1	01	01	H6750_012_2	5	1					1	06/06/2022	2023.01	06/06/2022 09:35:55 PM Eastern Daylight Time	08/03/2022 02:05:38 PM Eastern Daylight Time	08/02/2022 02:21:56 PM Eastern Daylight Time			08/05/2022 12:05:01 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	2023	New Hampshire	Most New Hampshire Counties	2		2			2									www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	013	0	1	01	01	H6750_013_0	5	1					1	06/06/2022	2023.01	06/06/2022 09:01:36 PM Eastern Daylight Time	08/03/2022 02:06:02 PM Eastern Daylight Time	08/02/2022 02:22:16 PM Eastern Daylight Time			08/05/2022 12:05:01 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	2023	Most of New Hampshire		2		2			2									www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	014	0	1	02	01	H6750_014_0	6	1					1	06/09/2022	2023.01	06/09/2022 11:10:33 AM Eastern Daylight Time	08/03/2022 02:06:28 PM Eastern Daylight Time	08/02/2022 02:22:36 PM Eastern Daylight Time			08/05/2022 12:05:01 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	2023	Most of New Hampshire		2		2			2									www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	807	0	1	01	01	H6750_807_0	2	1						06/06/2022	2023.01	06/06/2022 09:31:16 PM Eastern Daylight Time					07/19/2022 06:30:50 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 Rx (HMO)	01	01		1			H6750	807	0	2023	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	2	1						06/06/2022	2023.01	06/06/2022 09:34:12 PM Eastern Daylight Time					07/19/2022 06:30:50 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 Rx (HMO)	01	01		1			H6750	808	0	2023	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	2	1				0	0	06/06/2022	2023.01	06/06/2022 09:48:24 PM Eastern Daylight Time					07/19/2022 06:30:50 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 (HMO)	01	01		1			H6750	809	0	2023	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	2	1				0	0	06/06/2022	2023.01	06/06/2022 09:50:04 PM Eastern Daylight Time					07/19/2022 06:30:50 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 (HMO)	01	01		1			H6750	810	0	2023	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	2	1						06/06/2022	2023.01	06/06/2022 09:54:56 PM Eastern Daylight Time					07/19/2022 06:30:50 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 Rx (HMO-POS)	01	02		1			H6750	811	0	2023	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	2	1						06/06/2022	2023.01	06/06/2022 09:59:24 PM Eastern Daylight Time					07/19/2022 06:30:50 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 Rx (HMO-POS)	01	02		1			H6750	812	0	2023	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	2	1				0	0	06/06/2022	2023.01	06/06/2022 10:08:52 PM Eastern Daylight Time					07/19/2022 06:30:50 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 (HMO-POS)	01	02		1			H6750	813	0	2023	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	2	1				0	0	06/06/2022	2023.01	06/06/2022 10:10:19 PM Eastern Daylight Time					07/19/2022 06:30:50 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 (HMO-POS)	01	02		1			H6750	814	0	2023	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			
H6759	001	0	1	20	08	H6759_001_0	1	1						01/06/2023	2023.01	01/06/2023 10:13:37 AM Mountain Standard Time		01/06/2023 09:25:36 AM Mountain Standard Time			01/06/2023 10:16:34 AM Mountain Standard Time	SENIOR COMMUNITY CARE OF KENTUCKY	Senior CommUnity Care of Kentucky	https://www.voaseniorliving.org/care-types/program	Senior Community Care of KY-Dual Eligible (PACE)	08	20		1			H6759	001	0	2023	Jefferson County		2		2			2									https://pharmastar.com/	https://pharmastar.com/												(970)964-3500				(970)964-3500												(970)964-3500				(970)964-3500																
H6759	002	0	1	20	08	H6759_002_0	1	1						01/06/2023	2023.01	01/06/2023 10:14:05 AM Mountain Standard Time		01/06/2023 09:25:24 AM Mountain Standard Time			01/06/2023 10:16:34 AM Mountain Standard Time	SENIOR COMMUNITY CARE OF KENTUCKY	Senior CommUnity Care of Kentucky	https://www.voaseniorliving.org/care-types/program	Senior Community Care of KY-Medicare only (PACE)	08	20		1			H6759	002	0	2023	Jefferson County		2		2			2									https://pharmastar.com/	https://pharmastar.com/												(970)964-3500				(970)964-3500												(970)964-3500				(970)964-3500																
H6765	001	0	1	01	01	H6765_001_0	7	1		1				08/02/2022	2023.01	08/02/2022 12:09:36 PM Central Daylight Time	08/01/2022 11:07:14 PM Central Daylight Time	07/29/2022 05:33:00 PM Central Daylight Time			08/03/2022 09:32:37 AM Central Daylight Time	AMERICAN HEALTH PLAN OF IOWA INC	American Health Advantage of Iowa	IA.AmhealthPlans.com	American Health Advantage of Iowa (HMO I-SNP)	01	01		1			H6765	001	0	2023	Iowa		2		2			1	1	3							IA.AmhealthPlans.com	IA.AmhealthPlans.com	IA.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	1	01	7c;7i;	
H6776	001	0	1	01	01	H6776_001_0	8	1		1				06/27/2022	2023.01	06/27/2022 11:26:59 PM Eastern Daylight Time	06/05/2022 03:01:07 PM Eastern Daylight Time	06/05/2022 03:20:41 PM Eastern Daylight Time			06/27/2022 11:30:27 PM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	RiverSpring Health Plans	riverspringstar.org	RiverSpring Star (HMO I-SNP)	01	01		1			H6776	001	0	2023	Counties: Brx, Ki, Na, NY, Qu, Ri, Wes		2		2			1	1	3							riverspringstar.org	riverspringstar.org	riverspringstar.org	(800)580-7000		(800)580-7000		(800)580-7000		(800)580-7000		(800)580-7000		(800)580-7000		(800)580-7000		(800)580-7000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H6776	002	0	1	01	01	H6776_002_0	5	1	2	1			0	06/27/2022	2023.01	06/27/2022 11:27:57 PM Eastern Daylight Time	06/05/2022 02:56:18 PM Eastern Daylight Time	06/05/2022 03:18:11 PM Eastern Daylight Time			06/27/2022 11:30:27 PM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	RiverSpring Health Plans	riverspringMAP.org	RiverSpring MAP (HMO D-SNP)	01	01		1			H6776	002	0	2023	Counties: Brx, Ki, Na, NY, Qu, Ri, Wes		2		2			1	3		2					1	riverspringMAP.org	riverspringMAP.org	riverspringMAP.org	(800)362-2266		(800)362-2266		(800)362-2266		(800)362-2266		(800)362-2266		(800)362-2266		(800)362-2266		(800)362-2266		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H6787	001	0	1	20	08	H6787_001_0	1	1						05/10/2022	2023.01	05/10/2022 10:36:28 AM Mountain Daylight Time		06/01/2022 10:38:14 AM Mountain Daylight Time			06/01/2022 11:46:29 AM Mountain 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	2023	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						05/10/2022	2023.01	05/10/2022 10:36:44 AM Mountain Daylight Time		06/01/2022 10:38:15 AM Mountain Daylight Time			06/01/2022 11:46:29 AM Mountain 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	2023	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																
H6813	001	0	1	04	01	H6813_001_0	10	1					0	08/03/2022	2023.01	08/03/2022 03:16:22 PM US Eastern Daylight Time	08/04/2022 09:50:13 AM Eastern Daylight Time	08/04/2022 10:27:03 AM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Devoted Health	www.Devoted.com	Devoted CHOICE GIVEBACK Austin (PPO)	01	04		1			H6813	001	0	2023	Burnet, Caldwell, Hays, Travis, Williamson		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			
H6813	002	0	1	04	01	H6813_002_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:16:49 PM US Eastern Daylight Time	08/04/2022 09:50:38 AM Eastern Daylight Time	08/04/2022 10:27:22 AM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Devoted Health	www.Devoted.com	Devoted CHOICE Austin (PPO)	01	04		1			H6813	002	0	2023	Burnet, Caldwell, Hays, Travis, Williamson		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			
H6815	037	0	1	01	01	H6815_037_0	4	1						07/13/2022	2023.01	07/13/2022 04:20:11 PM Eastern Daylight Time	08/03/2022 07:42:33 PM Eastern Daylight Time	07/30/2022 10:10:11 AM Eastern Daylight Time			08/04/2022 05:06:33 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON, INC.	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare Assist (HMO)	01	01		1			H6815	037	0	2023	Select counties in OR		2		2			2									www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	038	0	1	01	01	H6815_038_0	4	1						08/03/2022	2023.01	08/03/2022 03:21:59 PM Eastern Daylight Time	08/03/2022 07:44:07 PM Eastern Daylight Time	07/30/2022 10:10:42 AM Eastern Daylight Time			08/04/2022 05:06:33 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON, INC.	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare No Premium (HMO)	01	01		1			H6815	038	0	2023	Select counties in OR		2		2			2									www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(844)582-5177		(844)582-5177		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	801	0	1	01	01	H6815_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:19:04 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON, INC.	Wellcare by Health Net	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H6815	801	0	2023	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)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:19:10 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON, INC.	Wellcare by Health Net	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H6815	802	0	2023	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)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:19:16 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON, INC.	Wellcare by Health Net	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H6815	803	0	2023	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)917-0175		(844)917-0175		(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	5	1						08/01/2022	2023.01	08/01/2022 12:52:03 PM Central Daylight Time	08/03/2022 08:52:24 PM Eastern Daylight Time	07/30/2022 10:11:13 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Via Christi Access Plus (PPO)	01	04		1			H6830	001	0	2023	Select counties in Kansas		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)816-6623		(833)816-6623		(866)281-2878		(866)281-2878		(833)816-6623		(833)816-6623		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6830	002	0	1	04	01	H6830_002_0	5	1						08/01/2022	2023.01	08/01/2022 12:53:01 PM Central Daylight Time	08/03/2022 08:53:38 PM Eastern Daylight Time	07/30/2022 10:11:45 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Via Christi Access (PPO)	01	04		1			H6830	002	0	2023	Select counties in Kansas		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)816-6623		(833)816-6623		(866)281-2878		(866)281-2878		(833)816-6623		(833)816-6623		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6832	001	0	1	01	01	H6832_001_0	4	1		1			1	08/04/2022	2023.01	08/04/2022 09:35:23 PM Eastern Daylight Time	08/05/2022 07:52:37 AM Mountain Daylight Time	08/05/2022 05:20:50 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	ALIGN SENIOR CARE MI, LLC	Align Senior Care	www.alignseniorcare.com	Align Thrive (HMO I-SNP)	01	01		1			H6832	001	0	2023	Michigan (partial)		2		2			1	1	3							www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com	(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6832	002	0	1	01	01	H6832_002_0	4	1		1			1	08/04/2022	2023.01	08/04/2022 09:36:27 PM Eastern Daylight Time	08/05/2022 07:53:04 AM Mountain Daylight Time	08/05/2022 05:21:09 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	ALIGN SENIOR CARE MI, LLC	Align Senior Care	www.alignseniorcare.com	Align Connect (HMO C-SNP)	01	01		1			H6832	002	0	2023	Michigan (partial)		2		2			1	4			00000100000000000000000					www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com	(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6832	003	0	1	01	01	H6832_003_0	6	1		1			1	07/12/2022	2023.01	07/12/2022 11:40:30 AM Eastern Daylight Time		08/04/2022 04:12:19 PM Eastern Daylight Time		08/04/2022 03:46:32 PM Eastern Daylight Time	08/19/2022 07:11:04 PM Eastern Daylight Time	ALIGN SENIOR CARE MI, LLC	Align Senior Care	www.alignseniorcare.com	Align Kidney Care (HMO C-SNP)	01	01		1			H6832	003	0	2023	Michigan (partial)		2		2			1	4			00000000100000000000000					www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com	(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(855)855-0336		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6846	001	0	1	20	08	H6846_001_0	1	1						06/01/2022	2023.01	06/01/2022 01:15:12 PM Eastern Daylight Time		06/01/2022 01:31:09 PM Eastern Daylight Time			06/01/2022 01:32:38 PM Eastern Daylight Time	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	CarePartners PACE	https://missionhealth.org/services-treatments	CarePartners PACE (PACE)	08	20		1			H6846	001	0	2023	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						06/01/2022	2023.01	06/01/2022 01:15:37 PM Eastern Daylight Time		06/01/2022 01:31:09 PM Eastern Daylight Time			06/01/2022 01:32:38 PM Eastern Daylight Time	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	CarePartners PACE	https://missionhealth.org/services-treatments	CarePartners PACE (PACE)	08	20		1			H6846	002	0	2023	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																
H6847	001	0	1	02	01	H6847_001_0	5	1						08/04/2022	2023.01	08/04/2022 03:41:16 PM Eastern Daylight Time	08/03/2022 03:05:24 PM Eastern Daylight Time	08/03/2022 03:30:21 PM Eastern Daylight Time			08/04/2022 04:19:05 PM Eastern Daylight Time	ALLWAYS HEALTH PARTNERS INC	AllWays Health Partners	www.allwayshealth.org	Mass General Brigham Advantage Secure (HMO-POS)	01	02		1			H6847	001	0	2023	Eastern Massachusetts		2		2			2									www.cvs.com	www.allwayshealth.org	www.allwayshealth.org	(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6847	801	0	1	02	01	H6847_801_0	2	1						06/02/2022	2023.01	06/02/2022 07:26:57 AM Eastern Daylight Time					06/03/2022 07:41:05 PM Eastern Daylight Time	ALLWAYS HEALTH PARTNERS INC	AllWays Health Partners	www.allwayshealth.org	Mass General Brigham Advantage Group (HMO-POS)	01	02		1			H6847	801	0	2023	Eastern Massachusetts		1	2400	2			2									www.cvs.com	www.allwayshealth.org	www.allwayshealth.org	(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(711)-		(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;11a;11b;11c;15;	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;	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;8b3;9a1;9a2;9b;9c;11a;11b;11c;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7f;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;	1				
H6851	001	0	1	01	01	H6851_001_0	11	1						08/04/2022	2023.01	08/04/2022 01:33:27 PM Eastern Daylight Time	08/03/2022 05:00:58 PM Eastern Daylight Time	08/03/2022 05:04:34 PM Eastern Daylight Time			08/05/2022 01:37:05 PM Eastern Daylight Time	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	WellSense Health Plan	wellsense.org/medicare	WellSense Added Value (HMO)	01	01		1			H6851	001	0	2023	All Counties_Value		2		2			2									wellsense.org/medicare	wellsense.org/medicare	wellsense.org/medicare	(855)833-8128		(855)833-8128		(800)967-4497		(800)967-4497		(855)833-8128		(855)833-8128		(800)967-4497		(800)967-4497		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6851	002	0	1	01	01	H6851_002_0	13	1						08/04/2022	2023.01	08/04/2022 01:34:24 PM Eastern Daylight Time	08/03/2022 05:02:02 PM Eastern Daylight Time	08/03/2022 05:05:54 PM Eastern Daylight Time			08/05/2022 01:37:05 PM Eastern Daylight Time	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	WellSense Health Plan	wellsense.org/medicare	WellSense Signature (HMO)	01	01		1			H6851	002	0	2023	All Counties_Signature		2		2			2									wellsense.org/medicare	wellsense.org/medicare	wellsense.org/medicare	(855)833-8128		(855)833-8128		(800)967-4497		(800)967-4497		(855)833-8128		(855)833-8128		(800)967-4497		(800)967-4497		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6851	003	0	1	01	01	H6851_003_0	13	1						08/04/2022	2023.01	08/04/2022 11:31:17 AM Eastern Daylight Time	08/03/2022 05:02:50 PM Eastern Daylight Time	08/03/2022 05:08:50 PM Eastern Daylight Time			08/05/2022 01:37:05 PM Eastern Daylight Time	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	WellSense Health Plan	wellsense.org/medicare	WellSense Choice (HMO)	01	01		1			H6851	003	0	2023	All Counties_Choice		2		2			2									wellsense.org/medicare	wellsense.org/medicare	wellsense.org/medicare	(855)833-8128		(855)833-8128		(800)967-4497		(800)967-4497		(855)833-8128		(855)833-8128		(800)967-4497		(800)967-4497		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6852	001	0	1	01	01	H6852_001_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:17:19 PM US Eastern Daylight Time	08/04/2022 09:51:01 AM Eastern Daylight Time	07/31/2022 01:54:13 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Devoted Health	www.Devoted.com	Devoted CORE Pennsylvania (HMO)	01	01		1			H6852	001	0	2023	Bucks, Chester, Delaware, Montgomery, Philadelphia		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			
H6852	002	0	1	01	01	H6852_002_0	11	1					0	08/03/2022	2023.01	08/03/2022 03:17:45 PM US Eastern Daylight Time	08/04/2022 09:51:26 AM Eastern Daylight Time	07/31/2022 01:54:35 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Devoted Health	www.Devoted.com	Devoted GIVEBACK Pennsylvania (HMO)	01	01		1			H6852	002	0	2023	Bucks, Chester, Delaware, Montgomery, Philadelphia		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			
H6870	001	0	1	48	05	H6870_001_0	4	1						09/08/2022	2023.01	09/08/2022 03:05:32 PM Eastern Daylight Time					09/08/2022 04:26:46 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN, INC.	Superior HealthPlan	mmp.superiorhealthplan.com	Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan)	05	48		1			H6870	001	0	2023	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	9	1					1	08/04/2022	2023.01	08/04/2022 02:25:41 PM Central Daylight Time	08/03/2022 10:58:57 AM Central Daylight Time	08/01/2022 07:33:11 PM Central Daylight Time			08/04/2022 05:46:23 PM Central Daylight Time	ASPIRUS HEALTH PLAN, INC.	Aspirus Health Plan	www.aspirushealthplan.com	Essential Rx (PPO)	01	04		1			H6874	001	0	2023	Central WI		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	7	1					1	05/31/2022	2023.01	05/31/2022 07:38:39 PM Central Daylight Time	08/03/2022 11:00:52 AM Central Daylight Time	08/01/2022 07:46:44 PM Central Daylight Time			08/04/2022 05:46:23 PM Central Daylight Time	ASPIRUS HEALTH PLAN, INC.	Aspirus Health Plan	www.aspirushealthplan.com	Elite Rx (PPO)	01	04		1			H6874	002	0	2023	Central WI		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	003	0	1	04	01	H6874_003_0	6	1				0	0	06/02/2022	2023.01	06/02/2022 01:30:01 PM Central Daylight Time	07/08/2022 12:20:04 PM Central Daylight Time				07/15/2022 11:53:27 AM Central Daylight Time	ASPIRUS HEALTH PLAN, INC.	Aspirus Health Plan	www.aspirushealthplan.com/medicare	Elite (PPO)	01	04		1			H6874	003	0	2023	Central WI		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)931-4852		(715)631-7413		(855)931-4852		(715)631-7413										2					2						2			
H6887	001	0	1	20	08	H6887_001_0	1	1						06/01/2022	2023.01	06/01/2022 05:50:01 PM Eastern Daylight Time		05/31/2022 06:10:32 PM Eastern Daylight Time			06/01/2022 05:54:44 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	2023	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						06/01/2022	2023.01	06/01/2022 05:51:51 PM Eastern Daylight Time		05/31/2022 06:10:55 PM Eastern Daylight Time			06/01/2022 05:54:44 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	2023	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	7	1		1				08/02/2022	2023.01	08/02/2022 12:10:05 PM Central Daylight Time	08/01/2022 11:09:44 PM Central Daylight Time	07/29/2022 05:31:14 PM Central Daylight Time			08/03/2022 09:32:37 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	2023	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	1	01	7c;7i;	
H6898	001	0	1	04	01	H6898_001_0	9	1					1	08/05/2022	2023.01	08/05/2022 06:40:00 PM Eastern Daylight Time	08/05/2022 06:05:09 PM Eastern Daylight Time	08/05/2022 06:42:50 PM Eastern Daylight Time			08/05/2022 06:49:14 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	2023	State of Vermont		2		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		(855)489-0646		(855)489-0646		(855)489-0646		(855)489-0646		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6898	002	0	1	04	01	H6898_002_0	9	1					1	08/05/2022	2023.01	08/05/2022 06:40:11 PM Eastern Daylight Time	08/05/2022 06:05:09 PM Eastern Daylight Time	08/05/2022 06:42:50 PM Eastern Daylight Time			08/05/2022 06:49:14 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	2023	State of Vermont		2		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		(855)489-0646		(855)489-0646		(855)489-0646		(855)489-0646		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6898	003	0	1	04	01	H6898_003_0	5	1				0	0	07/08/2022	2023.01	07/08/2022 04:11:24 PM Eastern Daylight Time	06/06/2022 07:05:47 PM Eastern Daylight Time				07/08/2022 05:01:51 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Tribute PPO (PPO)	01	04		1			H6898	003	0	2023	State of Vermont		2		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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6898	801	0	1	04	01	H6898_801_0	4	1						05/02/2022	2023.01	05/02/2022 11:39:27 AM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)489-0646		(855)489-0646		(855)489-0646		(855)489-0646		(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	4	1						05/02/2022	2023.01	05/02/2022 11:39:02 AM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)489-0646		(855)489-0646		(855)489-0646		(855)489-0646		(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	5	1						06/16/2022	2023.01	06/16/2022 08:36:03 AM Eastern Daylight Time					06/16/2022 08:36:42 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	2023	State of Vermont		1	107598	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		(855)489-0646		(855)489-0646		(855)489-0646		(855)489-0646		(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	06/16/2022	2023.01	06/16/2022 08:36:22 AM Eastern Daylight Time					06/16/2022 08:36:42 AM 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	2023	State of Vermont		1	3360	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	08/04/2022	2023.01	08/04/2022 09:14:11 AM Eastern Daylight Time	08/04/2022 05:54:26 PM Eastern Daylight Time	08/04/2022 05:54:26 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Saint Alphonsus Health Plan	www.MediGold.com	Saint Alphonsus Health Plan No Premium (HMO)	01	01		1			H6910	001	0	2023	Select Counties in Idaho		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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	08/04/2022	2023.01	08/04/2022 09:21:48 AM Eastern Daylight Time	08/04/2022 05:54:27 PM Eastern Daylight Time	08/04/2022 05:54:27 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Saint Alphonsus Health Plan	www.MediGold.com	Saint Alphonsus Health Plan Plus (HMO)	01	01		1			H6910	003	0	2023	Select Counties in Idaho		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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	07/12/2022	2023.01	07/12/2022 07:16:44 AM Eastern Daylight Time	06/06/2022 05:19:02 AM Eastern Daylight Time				07/12/2022 08:35:24 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Saint Alphonsus Health Plan	www.MediGold.com	Saint Alphonsus Health Plan Cash Back No Premium 2 (HMO)	01	01		1			H6910	004	0	2023	Select Counties in Idaho		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6910	005	0	1	01	01	H6910_005_0	5	1					0	08/04/2022	2023.01	08/04/2022 09:23:21 AM Eastern Daylight Time	08/04/2022 05:54:28 PM Eastern Daylight Time	08/04/2022 05:54:28 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Saint Alphonsus Health Plan	www.MediGold.com	Saint Alphonsus Health Plan Cash Back No Premium 1 (HMO)	01	01		1			H6910	005	0	2023	Select Counties in Idaho		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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	801	0	1	01	01	H6910_801_0	2	1						05/26/2022	2023.01	05/26/2022 02:50:13 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Saint Alphonsus Health Plan	www.MediGold.com	Saint Alphonsus Health Plan EGWP 1 (HMO)	01	01		1			H6910	801	0	2023	Select Counties in Idaho		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H6910	802	0	1	01	01	H6910_802_0	2	1						05/26/2022	2023.01	05/26/2022 02:54:08 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Saint Alphonsus Health Plan	www.MediGold.com	Saint Alphonsus Health Plan EGWP 2 (HMO)	01	01		1			H6910	802	0	2023	Select Counties in Idaho		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H6936	003	0	1	01	01	H6936_003_0	10	1						08/04/2022	2023.01	08/04/2022 02:38:39 PM US Mountain Standard Time	08/04/2022 09:05:26 AM US Mountain Standard Time	08/01/2022 03:46:43 PM US Mountain Standard Time			08/04/2022 02:48:51 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	2023	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						08/02/2022	2023.01	08/02/2022 03:15:29 PM US Mountain Standard Time	08/02/2022 03:46:36 PM US Mountain Standard Time	08/01/2022 03:46:52 PM US Mountain Standard Time			08/04/2022 02:48:51 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	2023	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	10	1						08/02/2022	2023.01	08/02/2022 03:17:17 PM US Mountain Standard Time	08/02/2022 03:33:40 PM US Mountain Standard Time	08/01/2022 03:47:00 PM US Mountain Standard Time			08/04/2022 02:48:51 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	2023	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						06/01/2022	2023.01	06/01/2022 12:08:04 PM Central Daylight Time		05/25/2022 08:08:04 PM Central Daylight Time			06/01/2022 12:11:17 PM Central Daylight Time	LIFE PACE	LIFE PACE, INC.	www.lifepace.org	LIFE PACE Dual Eligible 001 (PACE)	08	20		1			H6941	001	0	2023	Tulsa County and portions of surrounding counties		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						06/01/2022	2023.01	06/01/2022 12:09:09 PM Central Daylight Time		05/25/2022 08:13:50 PM Central Daylight Time			06/01/2022 12:11:17 PM Central Daylight Time	LIFE PACE	LIFE PACE, INC.	www.lifepace.org	LIFE PACE Medicare Only 002 (PACE)	08	20		1			H6941	002	0	2023	Tulsa County and portions of surrounding counties		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	8	1		1				08/17/2022	2023.01	08/17/2022 10:07:28 AM Central Daylight Time	08/03/2022 11:45:18 AM Central Daylight Time	08/02/2022 11:26:40 AM Central Daylight Time			08/17/2022 10:19:47 AM Central Daylight Time	ISNP VENTURES, LLC	KeyCare Advantage	www.keycareadvantage.com	KeyCare Advantage (HMO I-SNP)	01	01		1			H6959	001	0	2023	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	1		0	07/14/2022	2023.01	07/14/2022 08:08:16 AM Eastern Daylight Time	08/03/2022 09:32:37 PM Eastern Daylight Time	07/30/2022 10:12:16 AM Eastern Daylight Time			08/04/2022 05:23:51 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	2023	Select counties in AL		2		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	4	1						07/14/2022	2023.01	07/14/2022 08:14:16 AM Eastern Daylight Time	08/03/2022 09:34:03 PM Eastern Daylight Time	07/30/2022 10:12:48 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H6975	003	0	2023	Select counties in AL		2		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	1		0	07/14/2022	2023.01	07/14/2022 08:15:35 AM Eastern Daylight Time	08/03/2022 09:35:43 PM Eastern Daylight Time	07/30/2022 10:13:21 AM Eastern Daylight Time			08/04/2022 05:23:51 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	2023	Select counties in AL		2		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	4	1						08/01/2022	2023.01	08/01/2022 12:20:54 PM Eastern Daylight Time	08/03/2022 09:37:20 PM Eastern Daylight Time	07/30/2022 10:13:53 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H6975	005	0	2023	Select counties in AL		2		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	3	1				0	0	05/25/2022	2023.01	05/25/2022 04:42:49 PM Eastern Daylight Time	06/03/2022 08:39:51 PM Eastern Daylight Time				07/15/2022 04:36:04 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO)	01	01		1			H6975	006	0	2023	Select counties in AL		2		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	8	1						08/03/2022	2023.01	08/03/2022 05:35:25 PM Eastern Daylight Time	08/03/2022 10:17:55 AM Eastern Daylight Time	08/01/2022 02:16:14 PM Eastern Daylight Time			08/03/2022 05:36:34 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	2023	NYC Metro Area, ERIE, NASS, NIAG, ROCK Counties		2		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	8	1	2	1			0	07/18/2022	2023.01	07/18/2022 02:13:05 PM Eastern Daylight Time	08/03/2022 10:19:31 AM Eastern Daylight Time	08/01/2022 11:51:27 AM Eastern Daylight Time			08/03/2022 05:36:34 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	2023	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	8	1		1				05/31/2022	2023.01	05/31/2022 11:53:13 AM Eastern Daylight Time	08/03/2022 10:21:51 AM Eastern Daylight Time	08/01/2022 11:58:28 AM Eastern Daylight Time			08/03/2022 05:36:34 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	2023	NYC Metro, ER, NA, SU, RO, WE, NI, Counties		2		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	8	1	2	1			0	07/18/2022	2023.01	07/18/2022 02:22:54 PM Eastern Daylight Time	08/03/2022 10:23:37 AM Eastern Daylight Time	08/02/2022 10:49:40 AM Eastern Daylight Time			08/03/2022 05:36:34 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	2023	NYC Metro, ER, NA, SU, RO, WE, NI, 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						06/03/2022	2023.01	06/03/2022 04:50:18 PM Central Daylight Time		06/02/2022 07:29:54 AM Central Daylight Time			06/03/2022 04:58:17 PM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways Omaha	Immanuel.com	PACE Nebraska (PACE)	08	20		1			H7003	001	0	2023	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						06/03/2022	2023.01	06/03/2022 04:50:27 PM Central Daylight Time		06/02/2022 07:29:54 AM Central Daylight Time			06/03/2022 04:58:17 PM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways Omaha	immanuelpathways.org	PACE Nebraska (PACE)	08	20		1			H7003	002	0	2023	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	003	0	1	04	01	H7006_003_0	5	1						08/04/2022	2023.01	08/04/2022 10:17:48 AM Pacific Daylight Time	08/03/2022 02:45:23 PM Pacific Daylight Time	08/01/2022 10:57:04 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Prime Rx (PPO)	01	04		1			H7006	003	0	2023	Marion and Polk Counties		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	007	0	1	04	01	H7006_007_0	6	1						08/04/2022	2023.01	08/04/2022 10:18:14 AM Pacific Daylight Time	08/03/2022 02:45:52 PM Pacific Daylight Time	08/01/2022 10:57:36 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H7006	007	0	2023	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	010	0	1	04	01	H7006_010_0	5	1						08/04/2022	2023.01	08/04/2022 10:18:51 AM Pacific Daylight Time	08/03/2022 02:46:21 PM Pacific Daylight Time	08/01/2022 10:58:08 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	saintmarysatrio.com	Saint Mary's ATRIO Choice Rx (PPO)	01	04		1			H7006	010	0	2023	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	5	1						08/04/2022	2023.01	08/04/2022 10:19:09 AM Pacific Daylight Time	08/03/2022 02:46:50 PM Pacific Daylight Time	08/01/2022 10:58:40 AM Pacific Daylight Time			08/04/2022 06:59:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	saintmarysatrio.com	Saint Mary's ATRIO Select Rx (PPO)	01	04		1			H7006	011	0	2023	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			
H7020	004	0	1	01	01	H7020_004_0	4	1					1	08/02/2022	2023.01	08/02/2022 04:43:43 PM Central Daylight Time	08/02/2022 12:07:04 PM Central Daylight Time	08/01/2022 11:25:41 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7020	004	0	2023	Greenville/Spartanburg		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	005	0	1	01	01	H7020_005_0	2	1				0	0	05/24/2022	2023.01	05/24/2022 06:50:22 AM Central Daylight Time	05/31/2022 08:51:21 AM Central Daylight Time				06/02/2022 11:05:04 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H7020	005	0	2023	South Carolina		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7020	006	0	1	01	01	H7020_006_0	4	1					1	05/15/2022	2023.01	05/15/2022 08:59:40 AM Central Daylight Time	08/02/2022 12:07:51 PM Central Daylight Time	08/01/2022 11:26:13 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H7020	006	0	2023	Greenville/Spartanburg		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	008	0	1	01	01	H7020_008_0	4	1					1	08/02/2022	2023.01	08/02/2022 04:44:21 PM Central Daylight Time	08/02/2022 12:20:20 PM Central Daylight Time	08/01/2022 11:26:44 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7020	008	0	2023	Charleston		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	801	0	1	01	01	H7020_801_0	2	1						05/22/2022	2023.01	05/22/2022 05:40:08 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignahealthspring.com	Cigna Preferred Medicare (HMO)	01	01		1			H7020	801	0	2023	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				
H7028	001	0	1	04	01	H7028_001_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:18:37 PM US Eastern Daylight Time	08/04/2022 09:51:50 AM Eastern Daylight Time	07/31/2022 01:54:56 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA	Devoted Health	www.Devoted.com	Devoted CHOICE Upstate (PPO)	01	04		1			H7028	001	0	2023	Upstate South Carolina		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			
H7028	002	0	1	04	01	H7028_002_0	10	1					0	08/03/2022	2023.01	08/03/2022 03:19:18 PM US Eastern Daylight Time	08/04/2022 09:52:13 AM Eastern Daylight Time	07/31/2022 01:55:18 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA	Devoted Health	www.Devoted.com	Devoted CHOICE GIVEBACK Upstate (PPO)	01	04		1			H7028	002	0	2023	Upstate South Carolina		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			
H7063	001	0	1	04	01	H7063_001_0	6	1					0	08/05/2022	2023.01	08/05/2022 02:55:00 PM Central Daylight Time	08/04/2022 05:20:29 PM Central Daylight Time	08/04/2022 06:00:24 PM Central Daylight Time			08/05/2022 03:01:06 PM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare/ma-welcome	Blue Medicare Advantage (PPO)	01	04		1			H7063	001	0	2023	NE Region		2		2			2									www.MyPrime.com	www.bcbsks.com/medicare/forms	www.bcbsks.com/medicare/find-a-provider.shtml	(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						1	01	7a;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;7k;	
H7063	002	0	1	04	01	H7063_002_0	6	1					1	08/05/2022	2023.01	08/05/2022 02:54:47 PM Central Daylight Time	08/04/2022 05:21:38 PM Central Daylight Time	08/04/2022 06:09:31 PM Central Daylight Time			08/05/2022 03:01:06 PM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare/ma-welcome	Blue Medicare Advantage Comprehensive (PPO)	01	04		1			H7063	002	0	2023	NE Region		2		2			2									www.MyPrime.com	www.bcbsks.com/medicare/forms	www.bcbsks.com/medicare/find-a-provider.shtml	(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						1	01	7a;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;7k;	
H7063	006	0	1	04	01	H7063_006_0	6	1					0	08/05/2022	2023.01	08/05/2022 02:54:34 PM Central Daylight Time	08/04/2022 05:22:44 PM Central Daylight Time	08/04/2022 06:11:43 PM Central Daylight Time			08/05/2022 03:01:06 PM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare/ma-welcome	Blue Medicare Advantage (PPO)	01	04		1			H7063	006	0	2023	SC Region		2		2			2									www.MyPrime.com	www.bcbsks.com/medicare/forms	www.bcbsks.com/medicare/find-a-provider.shtml	(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						1	01	7a;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;7k;	
H7063	007	0	1	04	01	H7063_007_0	6	1					1	08/05/2022	2023.01	08/05/2022 02:55:40 PM Central Daylight Time	08/04/2022 05:23:52 PM Central Daylight Time	08/04/2022 06:22:27 PM Central Daylight Time			08/05/2022 03:01:06 PM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare/ma-welcome	Blue Medicare Advantage Comprehensive (PPO)	01	04		1			H7063	007	0	2023	SC Region		2		2			2									www.MyPrime.com	www.bcbsks.com/medicare/forms	www.bcbsks.com/medicare/find-a-provider.shtml	(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						1	01	7a;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;7k;	
H7063	012	0	1	04	01	H7063_012_0	8	1					0	08/05/2022	2023.01	08/05/2022 02:57:15 PM Central Daylight Time	08/04/2022 05:25:02 PM Central Daylight Time	08/04/2022 06:24:51 PM Central Daylight Time			08/05/2022 03:01:06 PM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare/ma-welcome	Blue Medicare Advantage Choice (PPO)	01	04		1			H7063	012	0	2023	NE and SC Region		2		2			2									www.MyPrime.com	www.bcbsks.com/medicare/forms	www.bcbsks.com/medicare/find-a-provider.shtml	(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						1	01	7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;7k;	
H7063	801	0	1	04	01	H7063_801_0	3	1						05/06/2022	2023.01	05/06/2022 04:41:44 PM Central Daylight Time					06/06/2022 05:10:37 PM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare/ma-welcome	MAPD Group Plan Calendar Year (PPO)	01	04		1			H7063	801	0	2023	Nationwide		1	0	2			2									www.MyPrime.com	www.bcbsks.com/medicare/forms	www.bcbsks.com/medicare/find-a-provider.shtml	(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	802	0	1	04	01	H7063_802_0	3	1						05/06/2022	2023.01	05/06/2022 04:45:57 PM Central Daylight Time					06/06/2022 05:10:37 PM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare/ma-welcome	MAPD Group Plan Calendar Year (PPO)	01	04		1			H7063	802	0	2023	Nationwide		1	0	2			2									www.MyPrime.com	www.bcbsks.com/medicare/forms	www.bcbsks.com/medicare/find-a-provider.shtml	(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			
H7074	001	0	1	04	01	H7074_001_0	5	1						08/05/2022	2023.01	08/05/2022 02:44:52 PM Pacific Daylight Time	08/05/2022 02:17:33 PM Pacific Daylight Time	08/02/2022 10:58:16 AM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health AVA (PPO)	01	04		1			H7074	001	0	2023	Mountains and Piedmont Regions		2		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						07/09/2022	2023.01	07/09/2022 09:59:45 AM Pacific Daylight Time					07/12/2022 04:15:18 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	2023	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						07/09/2022	2023.01	07/09/2022 09:59:54 AM Pacific Daylight Time					07/12/2022 04:15:18 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	2023	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	07/09/2022	2023.01	07/09/2022 10:00:10 AM Pacific Daylight Time					07/12/2022 04:15:18 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	2023	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	07/09/2022	2023.01	07/09/2022 10:00:24 AM Pacific Daylight Time					07/12/2022 04:15:18 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	2023	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	8	1	2	1			0	08/02/2022	2023.01	08/02/2022 11:25:12 AM Central Daylight Time	08/03/2022 10:01:24 AM Central Daylight Time	08/03/2022 09:38:16 AM Central Daylight Time			08/05/2022 01:43:08 PM Central Daylight Time	CARESOURCE INDIANA, INC.	CareSource	www.caresource.com/in/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H7076	015	0	2023	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	8	1	2	1			0	08/02/2022	2023.01	08/02/2022 11:26:35 AM Central Daylight Time	08/03/2022 09:59:44 AM Central Daylight Time	08/03/2022 09:36:48 AM Central Daylight Time			08/05/2022 01:43:08 PM Central Daylight Time	CARESOURCE INDIANA, INC.	CareSource	www.caresource.com/in/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H7076	016	0	2023	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	4	1				0	0	05/24/2022	2023.01	05/24/2022 11:44:32 AM Eastern Daylight Time	07/19/2022 05:09:22 PM Eastern Daylight Time				07/19/2022 07:50:24 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	2023	Indiana		2		2			2									https://www.anthem.com	https://www.anthem.com	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	6	1					1	08/01/2022	2023.01	08/01/2022 04:04:48 PM Eastern Daylight Time	08/04/2022 06:17:16 PM Eastern Daylight Time	08/04/2022 06:30:58 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	Indiana		2		2			2									https://www.anthem.com	https://www.anthem.com	https://shop.anthem.com/medicare	(833)681-2636		(833)681-2636		(855)593-0907		(855)593-0907		(833)409-1224		(833)409-1224		(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						06/01/2022	2023.01	06/01/2022 02:56:31 PM Central Daylight Time		06/01/2022 03:00:47 PM Central Daylight Time			06/01/2022 03:02:03 PM Central Daylight Time	VALIR PACE	Valir PACE Foundation	www.valirpace.org	Dual (PACE)	08	20		1			H7114	001	0	2023	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						06/01/2022	2023.01	06/01/2022 02:56:57 PM Central Daylight Time		06/01/2022 03:00:47 PM Central Daylight Time			06/01/2022 03:02:03 PM Central Daylight Time	VALIR PACE	Valir PACE Foundation	www.valirpace.org	Medicare Only (PACE)	08	20		1			H7114	002	0	2023	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	5	1					1	08/03/2022	2023.01	08/03/2022 12:01:05 PM Central Daylight Time	08/02/2022 02:18:57 PM Central Daylight Time	08/02/2022 02:29:38 PM Central Daylight Time			08/04/2022 10:29:42 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	001	0	2023	TX -Houston area		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	5	1					1	08/03/2022	2023.01	08/03/2022 12:01:22 PM Central Daylight Time	08/02/2022 02:21:57 PM Central Daylight Time	08/02/2022 02:30:36 PM Central Daylight Time			08/04/2022 10:29:42 AM 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	2023	TX -Houston area		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	5	1					1	08/03/2022	2023.01	08/03/2022 12:01:38 PM Central Daylight Time	08/02/2022 02:23:27 PM Central Daylight Time	08/02/2022 02:33:28 PM Central Daylight Time			08/04/2022 10:29:42 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage Golden Triangle (HMO)	01	01		1			H7115	004	0	2023	TX -Jefferson,Hardin		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	5	1	2	1			0	08/03/2022	2023.01	08/03/2022 12:02:08 PM Central Daylight Time	08/02/2022 02:25:20 PM Central Daylight Time	08/02/2022 02:31:55 PM Central Daylight Time			08/04/2022 10:29:42 AM 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	2023	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	006	0	1	01	01	H7115_006_0	5	1				0	0	07/13/2022	2023.01	07/13/2022 12:31:44 PM Central Daylight Time	07/14/2022 12:38:05 PM Central Daylight Time				07/18/2022 03:33:43 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Prime Value MA Only (HMO)	01	01		1			H7115	006	0	2023	TX -Harris,Montgomery,Fort Bend		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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7115	805	0	1	01	01	H7115_805_0	3	1						05/16/2022	2023.01	05/16/2022 10:56:40 AM Central Daylight Time					06/06/2022 05:19:13 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	805	0	2023	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	3	1						05/16/2022	2023.01	05/16/2022 10:56:56 AM Central Daylight Time					06/06/2022 05:19:13 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	806	0	2023	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	3	1				0	0	05/16/2022	2023.01	05/16/2022 10:57:11 AM Central Daylight Time					06/06/2022 05:19:13 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	807	0	2023	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	7	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 07:12:28 AM Eastern Daylight Time	08/05/2022 12:23:07 AM Eastern Daylight Time	08/05/2022 12:23:58 AM Eastern Daylight Time			08/05/2022 09:13:11 AM 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	2023	Southeastern Pennsylvania		2		2			1	3		1					1	https://www.upmchealthplan.com/snp/learn/plan-benefits/prescription-drug-coverage/	https://www.upmchealthplan.com/snp/learn/plan-benefits/prescription-drug-coverage/	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			
H7147	001	0	1	01	01	H7147_001_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 03:24:24 PM US Eastern Daylight Time	08/04/2022 09:52:41 AM Eastern Daylight Time	07/31/2022 01:55:39 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF COLORADO INC	Devoted Health	www.Devoted.com	Devoted CORE Colorado (HMO)	01	01		1			H7147	001	0	2023	El Paso, Teller, Larimer, and Weld 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			
H7147	003	0	1	01	01	H7147_003_0	9	1	2	1	1		0	07/21/2022	2023.01	07/21/2022 06:17:52 PM US Eastern Daylight Time	08/04/2022 09:53:11 AM Eastern Daylight Time	07/31/2022 01:56:01 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF COLORADO INC	Devoted Health	www.Devoted.com	Devoted DUAL Colorado - 1 (HMO D-SNP)	01	01		1			H7147	003	0	2023	El Paso, Teller, Denver		2		2			1	3		2					1	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			
H7147	004	0	1	01	01	H7147_004_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 03:24:56 PM US Eastern Daylight Time	08/04/2022 09:53:37 AM Eastern Daylight Time	07/31/2022 01:56:22 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF COLORADO INC	Devoted Health	www.Devoted.com	Devoted CORE Colorado (HMO)	01	01		1			H7147	004	0	2023	Denver		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			
H7147	005	0	1	01	01	H7147_005_0	11	1			2		0	08/03/2022	2023.01	08/03/2022 03:25:21 PM US Eastern Daylight Time	08/04/2022 09:54:06 AM Eastern Daylight Time	07/31/2022 01:56:43 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF COLORADO INC	Devoted Health	www.Devoted.com	Devoted GIVEBACK Colorado (HMO)	01	01		1			H7147	005	0	2023	Denver		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			
H7149	001	0	1	02	01	H7149_001_0	3	1						08/01/2022	2023.01	08/01/2022 01:11:07 PM Central Daylight Time	08/02/2022 01:01:43 PM Central Daylight Time	07/31/2022 11:45:36 PM Central Daylight Time			08/04/2022 09:41:18 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H7149	001	0	2023	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	006	0	1	01	01	H7149_006_0	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 01:01:06 PM Central Daylight Time	08/02/2022 01:02:31 PM Central Daylight Time	07/31/2022 11:46:02 PM Central Daylight Time			08/04/2022 10:17:20 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	2023	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	2	1				0	0	05/31/2022	2023.01	05/31/2022 08:26:54 PM Central Daylight Time	06/01/2022 01:04:55 PM Central Daylight Time				06/02/2022 03:10:36 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO-POS)	01	02		1			H7149	007	0	2023	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7149	801	0	1	01	01	H7149_801_0	1	1				0	0	05/30/2022	2023.01	05/30/2022 10:54:29 AM Eastern Daylight Time					06/02/2022 03:39:42 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H7149	801	0	2023	Nebraska		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H7149	802	0	1	01	01	H7149_802_0	1	1						05/26/2022	2023.01	05/26/2022 03:08:26 PM Eastern Daylight Time					06/02/2022 03:39:42 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	2023	Nebraska		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H7151	001	0	1	01	01	H7151_001_0	13	1					1	09/10/2022	2023.01	09/10/2022 12:49:16 AM US Eastern Daylight Time	08/04/2022 09:48:20 AM Eastern Daylight Time	07/31/2022 01:57:05 PM Eastern Daylight Time			09/27/2022 10:27:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Devoted Health	www.Devoted.com	Devoted CORE Illinois (HMO)	01	01		1			H7151	001	0	2023	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	08/03/2022	2023.01	08/03/2022 03:26:04 PM US Eastern Daylight Time	08/04/2022 09:48:53 AM Eastern Daylight Time	07/31/2022 01:57:26 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Devoted Health	www.Devoted.com	Devoted GIVEBACK Illinois (HMO)	01	01		1			H7151	003	0	2023	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	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:23:31 PM Central Daylight Time	08/03/2022 12:02:50 PM Central Daylight Time	08/01/2022 04:36:52 PM Central Daylight Time			08/03/2022 08:59:57 PM 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	2023	North, Central & 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7163	003	0	1	02	01	H7163_003_0	9	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 12:24:08 PM Central Daylight Time	08/03/2022 12:03:14 PM Central Daylight Time	08/01/2022 04:37:12 PM Central Daylight Time			08/03/2022 08:59:57 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	2023	North, Central & 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7163	004	0	1	02	01	H7163_004_0	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:24:40 PM Central Daylight Time	08/03/2022 12:03:38 PM Central Daylight Time	08/01/2022 04:37:30 PM Central Daylight Time			08/03/2022 08:59:57 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	2023	North, Central & 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7163	005	0	1	02	01	H7163_005_0	10	1			2		1	08/02/2022	2023.01	08/02/2022 12:25:09 PM Central Daylight Time	08/03/2022 12:04:02 PM Central Daylight Time	08/01/2022 04:37:48 PM Central Daylight Time			08/03/2022 08:59:57 PM Central Daylight Time	VANTAGE HEALTH PLAN OF MISSISSIPPI, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage Giveback (HMO-POS)	01	02		1			H7163	005	0	2023	North, Central & 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7163	801	0	1	02	01	H7163_801_0	5	1						05/16/2022	2023.01	05/16/2022 03:27:23 PM Central Daylight Time					06/01/2022 03:31:58 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	2023	State of 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	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7165	001	0	1	01	01	H7165_001_0	7	1					1	08/05/2022	2023.01	08/05/2022 11:46:28 AM Eastern Daylight Time	08/05/2022 10:45:40 AM Eastern Daylight Time	08/03/2022 01:39:20 PM Eastern Daylight Time			08/05/2022 12:35:01 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross Secure (HMO)	01	01		1			H7165	001	0	2023	Greenville County		2		2			2									www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7165	002	0	1	01	01	H7165_002_0	7	1					1	08/05/2022	2023.01	08/05/2022 11:25:12 AM Eastern Daylight Time	08/05/2022 10:46:19 AM Eastern Daylight Time	08/03/2022 01:40:35 PM Eastern Daylight Time			08/05/2022 12:35:01 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross Secure (HMO)	01	01		1			H7165	002	0	2023	Richland County		2		2			2									www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(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	1	1						05/19/2022	2023.01	05/19/2022 09:35:40 AM Eastern Daylight Time					06/02/2022 10:21:53 AM 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	2023	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	1	1a;1b;2;7k;8b2;9a1;9b;11a;15;	2		1					1				
H7165	806	0	1	01	01	H7165_806_0	1	1						05/19/2022	2023.01	05/19/2022 09:51:07 AM Eastern Daylight Time					06/02/2022 10:21:53 AM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross MAPD Non-Calendar Year (HMO)	01	01		1			H7165	806	0	2023	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	1	1a;1b;2;7k;8b1;8b2;9a1;9b;11a;11b;15;	2		1					1				
H7169	001	0	1	04	01	H7169_001_0	6	1						08/01/2022	2023.01	08/01/2022 01:02:23 PM Eastern Daylight Time	08/03/2022 08:05:01 PM Eastern Daylight Time	07/30/2022 10:14:25 AM Eastern Daylight Time			08/04/2022 05:16:49 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	2023	Select counties in OH		2		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			
H7169	003	0	1	04	01	H7169_003_0	7	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 11:29:56 AM Eastern Daylight Time	08/03/2022 08:06:17 PM Eastern Daylight Time	07/30/2022 10:14:58 AM Eastern Daylight Time			08/04/2022 05:16:49 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Wellcare	www.wellcare.com/allwellOH	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H7169	003	0	2023	Select Counties in Ohio		2		2			1	3		1					1	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			
H7169	004	0	1	04	01	H7169_004_0	6	1			2	0	0	07/14/2022	2023.01	07/14/2022 01:14:17 PM Eastern Daylight Time	06/03/2022 10:55:46 PM Eastern Daylight Time				07/15/2022 03:48:22 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Wellcare	www.wellcare.com/allwellOH	Wellcare Patriot Giveback Open (PPO)	01	04		1			H7169	004	0	2023	Select Counties in Ohio		2		2			2									In development	In development	www.wellcare.com/allwellOH	(855)766-1851		(855)766-1851		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7172	001	0	1	48	05	H7172_001_0	5	1						08/16/2022	2023.01	08/16/2022 11:57:25 AM Central Daylight Time					08/16/2022 12:01:44 PM Central Daylight Time	AETNA BETTER HEALTH INC. (OH)	Aetna Better Health of Ohio, MyCare Ohio	www.aetnabetterhealth.com/ohio	Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H7172	001	0	2023	Ohio		2	342000	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)-																
H7175	001	0	1	04	01	H7175_001_0	4	1						08/03/2022	2023.01	08/03/2022 02:16:56 PM Eastern Daylight Time	08/03/2022 08:20:52 PM Eastern Daylight Time	07/30/2022 10:15:30 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NC		2		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	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 01:52:16 PM Eastern Daylight Time	08/03/2022 08:22:05 PM Eastern Daylight Time	07/30/2022 10:16:02 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NC		2		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	4	1						05/31/2022	2023.01	05/31/2022 03:32:42 PM Eastern Daylight Time	08/03/2022 08:23:16 PM Eastern Daylight Time	07/30/2022 10:16:34 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NC		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:20:50 PM Eastern Daylight Time	08/03/2022 08:24:28 PM Eastern Daylight Time	07/30/2022 10:17:06 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NC		2		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	3	1				0	0	07/13/2022	2023.01	07/13/2022 05:13:59 PM Eastern Daylight Time	06/03/2022 07:27:44 PM Eastern Daylight Time				07/15/2022 03:46:22 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	2023	Select counties in NC		2		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	4	1						08/01/2022	2023.01	08/01/2022 01:52:51 PM Eastern Daylight Time	08/03/2022 08:25:40 PM Eastern Daylight Time	07/30/2022 10:17:37 AM Eastern Daylight Time			08/04/2022 05:27:00 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	2023	Select counties in NC		2		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						05/31/2022	2023.01	05/31/2022 10:17:45 AM Central Daylight Time		05/31/2022 10:07:15 AM Central Daylight Time			05/31/2022 10:19:44 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	2023	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						05/31/2022	2023.01	05/31/2022 10:18:09 AM Central Daylight Time		05/31/2022 10:07:15 AM Central Daylight Time			05/31/2022 10:19:44 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	2023	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																
H7199	001	0	1	04	01	H7199_001_0	9	1					1	08/03/2022	2023.01	08/03/2022 01:00:43 PM US Eastern Daylight Time	08/04/2022 09:54:36 AM Eastern Daylight Time	07/31/2022 01:57:48 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH  PLAN OF OREGON	Devoted Health	www.Devoted.com	Devoted CHOICE Oregon (PPO)	01	04		1			H7199	001	0	2023	Clackamas, Columbia, Multnomah, Washington		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			
H7199	002	0	1	04	01	H7199_002_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:26:37 PM US Eastern Daylight Time	08/04/2022 09:55:00 AM Eastern Daylight Time	07/31/2022 01:58:09 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH  PLAN OF OREGON	Devoted Health	www.Devoted.com	Devoted CHOICE PLUS Oregon (PPO)	01	04		1			H7199	002	0	2023	Clackamas, Columbia, Multnomah, Washington		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			
H7220	002	0	1	01	01	H7220_002_0	3	1				0	0	07/11/2022	2023.01	07/11/2022 10:00:40 AM Eastern Daylight Time	06/04/2022 12:57:11 PM Eastern Daylight Time				07/11/2022 10:44:10 AM 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	2023	State of Indiana - 31 counties		2		2			2									www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(800)455-9776		(317)963-9700										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7220	004	0	1	02	01	H7220_004_0	4	1					1	08/03/2022	2023.01	08/03/2022 06:25:58 PM Eastern Daylight Time	08/05/2022 01:36:48 PM Eastern Daylight Time	08/05/2022 01:36:48 PM Eastern Daylight Time			08/05/2022 01:46:17 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	2023	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	4	1					1	08/03/2022	2023.01	08/03/2022 06:26:25 PM Eastern Daylight Time	08/05/2022 01:36:48 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time			08/05/2022 01:46:17 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	2023	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	4	1					1	08/03/2022	2023.01	08/03/2022 06:26:48 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time			08/05/2022 01:46:17 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	2023	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	4	1					1	08/03/2022	2023.01	08/03/2022 06:27:15 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time			08/05/2022 01:46:17 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	2023	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	4	1					1	08/03/2022	2023.01	08/03/2022 06:27:40 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time			08/05/2022 01:46:17 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	2023	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			
H7220	011	0	1	02	01	H7220_011_0	4	1					1	08/03/2022	2023.01	08/03/2022 06:28:03 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time			08/05/2022 01:46:17 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	2023	State of Indiana - 34 counties		2		2			2									www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497		(844)432-0695		(844)432-0695		(866)327-7497		(866)327-7497		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7220	012	0	1	01	01	H7220_012_0	4	1					1	08/03/2022	2023.01	08/03/2022 06:28:31 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time	08/05/2022 01:36:49 PM Eastern Daylight Time			08/05/2022 01:46:17 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Kidney Care (HMO)	01	01		1			H7220	012	0	2023	State of Indiana - 9 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	806	0	1	02	01	H7220_806_0	2	1						06/04/2022	2023.01	06/04/2022 01:00:48 PM Eastern Daylight Time					06/04/2022 01:03:39 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Group 1 (HMO-POS)	01	02		1			H7220	806	0	2023	State of Indiana		1	0	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)-		1	2		2		1	2		2		1				
H7220	807	0	1	02	01	H7220_807_0	2	1						06/04/2022	2023.01	06/04/2022 01:00:59 PM Eastern Daylight Time					06/04/2022 01:03:39 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Group 2 (HMO-POS)	01	02		1			H7220	807	0	2023	State of Indiana		1	0	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)-		1	2		2		1	2		2		1				
H7220	808	0	1	01	01	H7220_808_0	2	1						06/04/2022	2023.01	06/04/2022 01:01:09 PM Eastern Daylight Time					06/04/2022 01:03:39 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Group 3 (HMO)	01	01		1			H7220	808	0	2023	State of Indiana		1	0	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)-		1	2		2		1					1				
H7220	809	0	1	01	01	H7220_809_0	2	1						06/04/2022	2023.01	06/04/2022 01:01:18 PM Eastern Daylight Time					06/04/2022 01:03:39 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Group 4 (HMO)	01	01		1			H7220	809	0	2023	State of Indiana		1	0	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)-		1	2		2		1					1				
H7245	001	0	1	01	01	H7245_001_0	6	1					1	08/04/2022	2023.01	08/04/2022 03:25:05 PM Pacific Daylight Time	08/05/2022 12:04:52 PM Pacific Daylight Time	08/05/2022 12:04:52 PM Pacific Daylight Time			08/05/2022 12:13:42 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	2023	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	6	1					1	08/04/2022	2023.01	08/04/2022 04:01:44 PM Pacific Daylight Time	08/05/2022 12:04:52 PM Pacific Daylight Time	08/05/2022 12:04:52 PM Pacific Daylight Time			08/05/2022 12:13:42 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	2023	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	6	1					1	07/08/2022	2023.01	07/08/2022 01:23:27 PM Pacific Daylight Time	08/05/2022 12:04:53 PM Pacific Daylight Time	08/05/2022 12:04:53 PM Pacific Daylight Time			08/05/2022 12:13:42 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	2023	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						06/01/2022	2023.01	06/01/2022 08:43:16 AM Mountain Daylight Time		06/01/2022 07:05:04 AM Mountain Daylight Time			06/01/2022 08:47:30 AM Mountain Daylight Time	TRU COMMUNITY CARE	TRU PACE	www.pace.trucare.org	TRU Community Care (PACE)	08	20		1			H7262	001	0	2023	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						06/01/2022	2023.01	06/01/2022 08:44:12 AM Mountain Daylight Time		06/01/2022 07:05:04 AM Mountain Daylight Time			06/01/2022 08:47:30 AM Mountain Daylight Time	TRU COMMUNITY CARE	TRU PACE	www.pace.trucare.org	TRU Community Care (PACE)	08	20		1			H7262	002	0	2023	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	9	1			1		1	08/17/2022	2023.01	08/17/2022 05:07:13 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time			08/17/2022 05:21:00 PM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Plus	www.bannerhealth.com/medicare/	Banner Medicare Advantage Plus (PPO)	01	04		1			H7273	001	0	2023	Maricopa, Pinal Counties		2		2			2									www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	(844)549-1859		(602)462-0830		(844)556-7685		(602)755-4192		(844)549-1859		(602)462-0830		(844)556-7685		(602)755-4192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7273	002	0	1	04	01	H7273_002_0	9	1			1		1	08/17/2022	2023.01	08/17/2022 05:10:28 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time			08/17/2022 05:21:00 PM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Plus	www.bannerhealth.com/medicare/	Banner Medicare Advantage Plus (PPO)	01	04		1			H7273	002	0	2023	Pima and Santa Cruz Counties		2		2			2									www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	(844)549-1859		(602)462-0830		(844)556-7685		(602)755-4192		(844)549-1859		(602)462-0830		(844)556-7685		(602)755-4192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7273	005	0	1	04	01	H7273_005_0	9	1			1		1	08/17/2022	2023.01	08/17/2022 05:13:03 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time	08/05/2022 12:43:44 PM US Mountain Standard Time			08/17/2022 05:21:00 PM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Plus	www.bannerhealth.com/medicare/	Banner Medicare Advantage Plus (PPO)	01	04		1			H7273	005	0	2023	Yuma County		2		2			2									www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/	(844)549-1859		(602)462-0830		(844)556-7685		(602)755-4192		(844)549-1859		(602)462-0830		(844)556-7685		(602)755-4192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	001	0	1	04	01	H7284_001_0	3	1			1		1	07/07/2022	2023.01	07/07/2022 11:27:03 AM Eastern Daylight Time	08/03/2022 05:50:58 PM Eastern Daylight Time	07/30/2022 09:45:24 AM Eastern Daylight Time			08/04/2022 02:00:04 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	2023	Lake, Marion, Seminole and Sumter counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 02:03:28 PM Eastern Daylight Time	08/03/2022 05:53:50 PM Eastern Daylight Time	07/30/2022 09:45:48 AM Eastern Daylight Time			08/04/2022 02:00:04 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	2023	Rural North Florida		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/04/2022	2023.01	08/04/2022 03:39:32 PM Eastern Daylight Time	08/03/2022 05:58:10 PM Eastern Daylight Time	07/30/2022 09:46:14 AM Eastern Daylight Time			08/04/2022 04:08:34 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	2023	Daytona and Jacksonville Metro area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/03/2022	2023.01	08/03/2022 04:37:17 PM Eastern Daylight Time	08/03/2022 05:28:20 PM Eastern Daylight Time	07/30/2022 09:46:38 AM Eastern Daylight Time			08/04/2022 01:45:35 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	2023	Southeast Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/03/2022	2023.01	08/03/2022 04:38:57 PM Eastern Daylight Time	08/03/2022 05:27:53 PM Eastern Daylight Time	07/30/2022 09:47:04 AM Eastern Daylight Time			08/04/2022 01:45:35 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	2023	Broward, Miami-Dade, and Palm Beach counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/04/2022	2023.01	08/04/2022 03:39:43 PM Eastern Daylight Time	08/03/2022 06:00:04 PM Eastern Daylight Time	07/30/2022 09:47:28 AM Eastern Daylight Time			08/04/2022 04:08:34 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	2023	North and Rural Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	010	0	1	04	01	H7284_010_0	4	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 04:42:17 PM Eastern Daylight Time	08/03/2022 05:30:08 PM Eastern Daylight Time	07/30/2022 09:47:54 AM Eastern Daylight Time			08/04/2022 01:45:35 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana	www.humana.com/medicare	HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP)	01	04		1			H7284	010	0	2023	Southeast Florida		2		2			1	3		2					2	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1						07/22/2022	2023.01	07/22/2022 01:08:12 PM Eastern Daylight Time	08/03/2022 03:26:56 PM Eastern Daylight Time	08/01/2022 12:46:30 AM Eastern Daylight Time			08/04/2022 05:22:35 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	2023	IL Northern		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(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	3	1						08/02/2022	2023.01	08/02/2022 10:53:28 AM Eastern Daylight Time	08/03/2022 03:27:51 PM Eastern Daylight Time	08/01/2022 12:46:56 AM Eastern Daylight Time			08/04/2022 05:22:35 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	2023	IL Northern		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(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						08/02/2022	2023.01	08/02/2022 06:02:59 PM Central Daylight Time	08/02/2022 01:29:24 PM Central Daylight Time	07/31/2022 11:47:24 PM Central Daylight Time			08/04/2022 09:38:27 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	2023	Central 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						05/31/2022	2023.01	05/31/2022 08:27:48 PM Central Daylight Time	08/02/2022 01:30:26 PM Central Daylight Time	07/31/2022 11:47:50 PM Central Daylight Time			08/04/2022 09:38:27 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	2023	Central 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	3	1						08/10/2022	2023.01	08/10/2022 02:14:06 PM Central Daylight Time	08/02/2022 01:31:25 PM Central Daylight Time	07/31/2022 11:48:16 PM Central Daylight Time			08/10/2022 02:25:56 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	2023	Metro St Louis-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	012	0	1	04	01	H7301_012_0	3	1						08/10/2022	2023.01	08/10/2022 02:14:31 PM Central Daylight Time	08/02/2022 01:32:24 PM Central Daylight Time	07/31/2022 11:48:44 PM Central Daylight Time			08/10/2022 02:25:56 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	2023	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			
H7301	801	0	1	04	01	H7301_801_0	1	1						05/26/2022	2023.01	05/26/2022 03:13:42 PM Eastern Daylight Time					06/02/2022 03:41:16 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	2023	Illinois		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H7301	803	0	1	04	01	H7301_803_0	1	1				0	0	05/26/2022	2023.01	05/26/2022 03:18:40 PM Eastern Daylight Time					06/02/2022 03:41:16 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	2023	Illinois		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H7323	002	0	1	04	01	H7323_002_0	4	1						08/01/2022	2023.01	08/01/2022 11:04:32 PM Eastern Daylight Time	08/03/2022 09:41:46 PM Eastern Daylight Time	07/30/2022 10:18:08 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		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			2		1	08/03/2022	2023.01	08/03/2022 02:49:35 PM Eastern Daylight Time	08/03/2022 09:42:58 PM Eastern Daylight Time	07/30/2022 10:18:48 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		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	5	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 10:43:16 AM Eastern Daylight Time	08/03/2022 09:44:02 PM Eastern Daylight Time	07/30/2022 10:19:27 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		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						08/03/2022	2023.01	08/03/2022 02:51:10 PM Eastern Daylight Time	08/03/2022 09:45:03 PM Eastern Daylight Time	07/30/2022 10:20:01 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		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						08/01/2022	2023.01	08/01/2022 11:20:27 PM Eastern Daylight Time	08/03/2022 09:46:13 PM Eastern Daylight Time	07/30/2022 10:20:34 AM Eastern Daylight Time			08/04/2022 05:26:29 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	2023	Select counties in TX		2		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	009	0	1	04	01	H7323_009_0	4	1						08/03/2022	2023.01	08/03/2022 02:53:31 PM Eastern Daylight Time	08/04/2022 09:56:10 AM Eastern Daylight Time	07/30/2022 10:21:06 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellTX	Wellcare No Premium Open (PPO)	01	04		1			H7323	009	0	2023	Select Counties in Texas		2		2			2									www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(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	010	0	1	04	01	H7323_010_0	5	1			2		0	08/01/2022	2023.01	08/01/2022 11:37:38 PM Eastern Daylight Time	08/03/2022 09:48:55 PM Eastern Daylight Time	07/30/2022 10:21:37 AM Eastern Daylight Time			08/04/2022 05:26:29 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H7323	010	0	2023	Select Counties in Texas		2		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	4	1						08/01/2022	2023.01	08/01/2022 01:05:05 PM Eastern Daylight Time	08/03/2022 08:01:33 PM Central Daylight Time	07/30/2022 09:22:09 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H7326	001	0	2023	All counties in SC		2		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						08/03/2022	2023.01	08/03/2022 03:19:15 PM Eastern Daylight Time	08/03/2022 08:02:48 PM Central Daylight Time	07/30/2022 09:22:41 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H7326	003	0	2023	All counties in SC		2		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	006	0	1	04	01	H7326_006_0	6	1	2	1	1		0	07/19/2022	2023.01	07/19/2022 09:14:37 AM Eastern Daylight Time	08/03/2022 08:04:01 PM Central Daylight Time	07/30/2022 09:23:14 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty Open (PPO D-SNP)	01	04		1			H7326	006	0	2023	Select Counties in South Carolina		2		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			
H7326	007	0	1	04	01	H7326_007_0	4	1						06/01/2022	2023.01	06/01/2022 06:41:06 PM Eastern Daylight Time	08/03/2022 08:05:12 PM Central Daylight Time	07/30/2022 09:23:46 AM Central Daylight Time			08/04/2022 04:34:53 PM Central Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H7326	007	0	2023	Select Counties in South Carolina		2		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	08/05/2022	2023.01	08/05/2022 09:03:51 AM Central Daylight Time	08/05/2022 09:14:34 AM Central Daylight Time	08/05/2022 09:15:24 AM Central Daylight Time			08/05/2022 10:18:03 AM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing Choice IL (HMO)	01	01		1			H7330	001	0	2023	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	08/05/2022	2023.01	08/05/2022 09:04:10 AM Central Daylight Time	08/05/2022 09:14:34 AM Central Daylight Time	08/05/2022 09:15:24 AM Central Daylight Time			08/05/2022 10:18:03 AM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing Open Access IL (HMO-POS)	01	02		1			H7330	002	0	2023	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	08/05/2022	2023.01	08/05/2022 09:04:29 AM Central Daylight Time	08/05/2022 09:14:34 AM Central Daylight Time	08/05/2022 09:15:25 AM Central Daylight Time			08/05/2022 10:18:03 AM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing Essential Wellness Diabetes and Heart IL (HMO C-SNP)	01	01		1			H7330	003	0	2023	DeKalb, DuPage, Kankakee & Lake Counties		2		2			1	4			00000000000000000010000					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	8	1					1	08/05/2022	2023.01	08/05/2022 09:04:47 AM Central Daylight Time	08/05/2022 09:14:34 AM Central Daylight Time	08/05/2022 09:15:25 AM Central Daylight Time			08/05/2022 10:18:03 AM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing Signature Care IL (HMO-POS)	01	02		1			H7330	004	0	2023	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	005	0	1	01	01	H7330_005_0	9	1					1	08/10/2022	2023.01	08/10/2022 09:58:03 AM Central Daylight Time	08/05/2022 09:14:35 AM Central Daylight Time	08/05/2022 09:15:25 AM Central Daylight Time			08/10/2022 11:32:40 AM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing Premium Giveback IL (HMO)	01	01		1			H7330	005	0	2023	Various Illinois 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	801	0	1	01	01	H7330_801_0	3	1						06/02/2022	2023.01	06/02/2022 11:00:36 AM Central Daylight Time					06/05/2022 05:29:01 PM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing EGWP CY (HMO)	01	01		1			H7330	801	0	2023	Various Illinois 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	3	1						06/02/2022	2023.01	06/02/2022 11:00:46 AM Central Daylight Time					06/05/2022 05:29:01 PM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing EGWP NCY (HMO)	01	01		1			H7330	802	0	2023	Various Illinois 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	3	1				0	0	06/02/2022	2023.01	06/02/2022 11:00:54 AM Central Daylight Time					06/05/2022 05:29:01 PM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing EGWP MA Only CY (HMO)	01	01		1			H7330	803	0	2023	Various Illinois 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	3	1				0	0	06/02/2022	2023.01	06/02/2022 01:02:29 PM Central Daylight Time					06/05/2022 05:29:01 PM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing EGWP MA Only NCY (HMO)	01	01		1			H7330	804	0	2023	Various Illinois 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	5	1						08/03/2022	2023.01	08/03/2022 03:30:44 PM Eastern Daylight Time	08/03/2022 08:38:32 PM Eastern Daylight Time	07/30/2022 10:24:18 AM Eastern Daylight Time			08/04/2022 05:10:27 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Wellcare by Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium Open (PPO)	01	04		1			H7360	001	0	2023	Select counties in CA		2		2			2									www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(800)275-4737		(800)275-4737		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7366	001	0	1	20	08	H7366_001_0	3	1						07/29/2022	2023.01	07/29/2022 12:07:30 PM Cuba Daylight Time		07/29/2022 12:34:35 PM Cuba Daylight Time			07/29/2022 12:35:44 PM Cuba Daylight Time	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	ConcertoHealth PACE of Los Angeles	www.concertohealthpace.com	ConcertoPACE of LA - Dual Eligible (PACE)	08	20		1			H7366	001	0	2023	Los Angeles		2		2			2									www.carekinesses.com	www.concertohealthpace.com												(213)943-2490				(213)943-2490												(213)943-2490				(213)943-2490																
H7366	002	0	1	20	08	H7366_002_0	3	1						07/29/2022	2023.01	07/29/2022 12:07:57 PM Cuba Daylight Time		07/29/2022 12:34:35 PM Cuba Daylight Time			07/29/2022 12:35:44 PM Cuba Daylight Time	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	ConcertoHealth PACE of Los Angeles	www.concertohealthpace.com	ConcertoPACE of LA - Medicare Only (PACE)	08	20		1			H7366	002	0	2023	Los Angeles		2		2			2									www.carekinesses.com	www.concertohealthpace.com												(213)943-2490				(213)943-2490												(213)943-2490				(213)943-2490																
H7379	801	0	1	04	01	H7379_801_0	6	1						05/23/2022	2023.01	05/23/2022 01:47:39 PM Eastern Daylight Time					06/06/2022 02:39:07 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	2023	United States and Territories		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		(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	802	0	1	04	01	H7379_802_0	6	1				0	0	05/23/2022	2023.01	05/23/2022 01:48:05 PM Eastern Daylight Time					06/06/2022 02:39:07 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	2023	United States and Territories		1	6000	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	6	1						05/23/2022	2023.01	05/23/2022 01:48:15 PM Eastern Daylight Time					06/06/2022 02:39:07 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	2023	United States and Territories		1	0	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	6	1				0	0	05/23/2022	2023.01	05/23/2022 01:48:19 PM Eastern Daylight Time					06/06/2022 02:39:07 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	2023	United States and Territories		1	0	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;9c;10a;11a;11b;11c;15;16b;	2		1									
H7389	001	0	1	01	01	H7389_001_0	5	1					1	08/02/2022	2023.01	08/02/2022 06:59:15 PM Central Daylight Time	08/02/2022 11:25:41 AM Central Daylight Time	08/01/2022 11:27:15 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H7389	001	0	2023	Salt Lake City		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(866)624-0168		(866)624-0168		(800)668-3813		(800)668-3813		(866)624-0168		(866)624-0168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7389	002	0	1	01	01	H7389_002_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:32:12 PM Central Daylight Time	08/01/2022 05:34:33 PM Central Daylight Time	08/01/2022 11:27:47 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7389	002	0	2023	Portland		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(877)602-6226		(877)602-6226		(800)668-3813		(800)668-3813		(877)602-6226		(877)602-6226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7389	003	0	1	01	01	H7389_003_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:46:01 PM Central Daylight Time	08/02/2022 06:15:03 PM Central Daylight Time	08/01/2022 11:28:18 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7389	003	0	2023	St. Louis		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7389	004	0	1	01	01	H7389_004_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:46:14 PM Central Daylight Time	08/02/2022 06:16:31 PM Central Daylight Time	08/01/2022 11:28:50 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7389	004	0	2023	Southern Illinois		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7389	005	0	1	01	01	H7389_005_0	5	1						06/01/2022	2023.01	06/01/2022 06:41:11 PM Central Daylight Time	08/02/2022 06:17:44 PM Central Daylight Time	08/01/2022 11:29:21 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H7389	005	0	2023	Southern Illinois		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7399	001	0	1	01	01	H7399_001_0	5	1						08/03/2022	2023.01	08/03/2022 01:05:19 PM Central Daylight Time	08/03/2022 09:31:08 PM Eastern Daylight Time	07/30/2022 10:24:49 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ILLINOIS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Illinois Reward (HMO)	01	01		1			H7399	001	0	2023	Cook, DuPage, Kankakee, Kane and Will Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)293-5966		(833)293-5966		(866)281-2878		(866)281-2878		(833)293-5966		(833)293-5966		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7399	002	0	1	01	01	H7399_002_0	6	1						08/01/2022	2023.01	08/01/2022 12:55:02 PM Central Daylight Time	08/03/2022 09:32:07 PM Eastern Daylight Time	07/30/2022 10:25:20 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ILLINOIS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Illinois Secure (HMO)	01	01		1			H7399	002	0	2023	Cook, DuPage, Kankakee, Kane and Will Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)293-5966		(833)293-5966		(866)281-2878		(866)281-2878		(833)293-5966		(833)293-5966		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7404	001	0	1	04	01	H7404_001_0	4	1					1	08/05/2022	2023.01	08/05/2022 10:59:51 AM Central Daylight Time	08/03/2022 10:58:31 AM Central Daylight Time	07/31/2022 03:38:19 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Headwaters (PPO)	01	04		1			H7404	001	0	2023	Twin Cities Metro 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						2			
H7404	002	0	1	04	01	H7404_002_0	4	1					1	08/05/2022	2023.01	08/05/2022 11:00:27 AM Central Daylight Time	08/03/2022 10:59:09 AM Central Daylight Time	07/31/2022 03:38:44 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Lakeshore (PPO)	01	04		1			H7404	002	0	2023	Twin Cities Metro 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						2			
H7404	004	0	1	04	01	H7404_004_0	4	1					0	08/05/2022	2023.01	08/05/2022 11:00:36 AM Central Daylight Time	08/03/2022 10:59:47 AM Central Daylight Time	07/31/2022 03:39:09 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Premier (PPO)	01	04		1			H7404	004	0	2023	Select Counties in Minnesota and North Dakota		2		2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	005	0	1	04	01	H7404_005_0	4	1					1	08/05/2022	2023.01	08/05/2022 11:00:48 AM Central Daylight Time	08/03/2022 11:00:25 AM Central Daylight Time	07/31/2022 03:39:34 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Headwaters (PPO)	01	04		1			H7404	005	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:29:33 AM Central Daylight Time	08/03/2022 11:01:02 AM Central Daylight Time	07/31/2022 03:39:58 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Lakeshore (PPO)	01	04		1			H7404	006	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:29:41 AM Central Daylight Time	08/03/2022 11:01:40 AM Central Daylight Time	07/31/2022 03:40:23 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Headwaters (PPO)	01	04		1			H7404	011	0	2023	Select Counties in Minnesota		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	4	1					1	08/05/2022	2023.01	08/05/2022 11:29:50 AM Central Daylight Time	08/03/2022 11:02:17 AM Central Daylight Time	07/31/2022 03:40:48 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Lakeshore (PPO)	01	04		1			H7404	012	0	2023	Select Counties in Minnesota		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	4	1					1	08/05/2022	2023.01	08/05/2022 11:29:57 AM Central Daylight Time	08/03/2022 11:02:54 AM Central Daylight Time	07/31/2022 03:41:12 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Riverbank (PPO)	01	04		1			H7404	014	0	2023	Twin Cities Metro 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						2			
H7404	015	0	1	04	01	H7404_015_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 11:20:28 AM Central Daylight Time	06/01/2022 10:43:14 AM Central Daylight Time				06/02/2022 11:44:59 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H7404	015	0	2023	Select Counties in Minnesota and North Dakota		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	2	1					1	08/02/2022	2023.01	08/02/2022 11:38:30 AM Central Daylight Time	08/03/2022 11:03:32 AM Central Daylight Time	07/31/2022 03:41:37 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H7404	018	0	2023	Clark and Nye counties		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	019	0	1	04	01	H7404_019_0	1	1				0	0	06/01/2022	2023.01	06/01/2022 08:43:33 AM Central Daylight Time	06/01/2022 10:44:27 AM Central Daylight Time				06/03/2022 11:13:47 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H7404	019	0	2023	Clark and Nye 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			
H7404	020	0	1	04	01	H7404_020_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:40:49 AM Central Daylight Time	08/03/2022 11:04:09 AM Central Daylight Time	07/31/2022 03:42:02 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (PPO)	01	04		1			H7404	020	0	2023	Clark and Nye counties		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	021	0	1	04	01	H7404_021_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:44:17 AM Central Daylight Time	08/03/2022 11:04:46 AM Central Daylight Time	07/31/2022 03:42:26 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H7404	021	0	2023	Select counties in Northern 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			
H7404	022	0	1	04	01	H7404_022_0	4	1					1	08/05/2022	2023.01	08/05/2022 11:30:07 AM Central Daylight Time	08/03/2022 11:05:23 AM Central Daylight Time	07/31/2022 03:42:51 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Riverbank (PPO)	01	04		1			H7404	022	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:30:15 AM Central Daylight Time	08/03/2022 11:06:01 AM Central Daylight Time	07/31/2022 03:43:15 AM Central Daylight Time			08/05/2022 11:55:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Riverbank (PPO)	01	04		1			H7404	023	0	2023	Select Counties in Minnesota		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	024	0	1	04	01	H7404_024_0	2	1					1	08/02/2022	2023.01	08/02/2022 11:47:14 AM Central Daylight Time	08/03/2022 11:06:38 AM Central Daylight Time	07/31/2022 03:43:40 AM Central Daylight Time			08/04/2022 03:47:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Rebate (PPO)	01	04		1			H7404	024	0	2023	Select counties in Northern 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			
H7419	001	0	1	48	05	H7419_001_0	2	1						06/22/2022	2023.01	06/22/2022 01:27:21 PM Eastern Daylight Time					06/22/2022 01:35:50 PM Eastern Daylight Time	TUFTS HEALTH PUBLIC PLANS, INC.	Tufts Health Plan	tuftshealthunify.org	Tufts Health Unify (Medicare-Medicaid Plan)	05	48		1			H7419	001	0	2023	Counties: NOR, PLY, BRI, MID, SUF, WOR, ESS, BAR		2	63164	2			2									tuftshealthunify.org	tuftshealthunify.org	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	02	01	H7445_005_0	2	1					1	08/04/2022	2023.01	08/04/2022 02:37:30 PM Central Daylight Time	08/03/2022 10:43:30 AM Central Daylight Time	07/31/2022 03:44:04 AM Central Daylight Time			08/04/2022 05:25:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H7445	005	0	2023	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	02	01	H7445_006_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 09:19:20 PM Central Daylight Time	06/01/2022 12:10:22 PM Central Daylight Time				06/02/2022 02:51:13 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H7445	006	0	2023	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	02	01	H7464_001_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 11:06:02 AM Central Daylight Time	08/03/2022 11:51:05 AM Central Daylight Time	07/31/2022 03:44:29 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H7464	001	0	2023	State of 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	02	01	H7464_005_0	3	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 10:31:25 AM Central Daylight Time	08/03/2022 11:51:45 AM Central Daylight Time	07/31/2022 03:44:55 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP)	01	02		1			H7464	005	0	2023	State of 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	02	01	H7464_006_0	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 11:12:59 AM Central Daylight Time	08/03/2022 11:52:24 AM Central Daylight Time	07/31/2022 03:45:21 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Balance (HMO-POS D-SNP)	01	02		1			H7464	006	0	2023	State of 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	02	01	H7464_007_0	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 10:32:09 AM Central Daylight Time	08/03/2022 11:53:04 AM Central Daylight Time	07/31/2022 03:45:46 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE Plus (HMO-POS D-SNP)	01	02		1			H7464	007	0	2023	State of 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	2	1	2	1	1		0	08/02/2022	2023.01	08/02/2022 04:46:04 PM Central Daylight Time	08/03/2022 11:53:41 AM Central Daylight Time	07/31/2022 03:46:11 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	Select counties in Maryland	Greater Maryland	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			
H7464	008	2	1	02	01	H7464_008_2	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 10:33:48 AM Central Daylight Time	08/03/2022 11:54:19 AM Central Daylight Time	07/31/2022 03:46:37 AM Central Daylight Time			08/04/2022 03:25:02 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	2023	Select counties in Maryland	Baltimore Metro Area	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			
H7464	010	0	1	01	01	H7464_010_0	5	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 04:09:27 PM Central Daylight Time	08/03/2022 11:55:07 AM Central Daylight Time	07/31/2022 03:47:02 AM Central Daylight Time			08/05/2022 09:50:40 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Choice One (HMO D-SNP)	01	01		1			H7464	010	0	2023	Washington, DC		2		2			1	3		1					1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)242-7726		(866)242-7726		(888)834-3721		(888)834-3721		(866)242-7726		(866)242-7726		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7464	011	0	1	02	01	H7464_011_0	3	1	2	1	1		0	08/12/2022	2023.01	08/12/2022 09:55:04 AM Central Daylight Time	08/03/2022 11:55:48 AM Central Daylight Time	07/31/2022 03:47:28 AM Central Daylight Time			08/12/2022 10:01:01 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)	01	02		1			H7464	011	0	2023	Select counties in Maryland		2		2			1	3		2					2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)242-7726		(866)242-7726		(888)834-3721		(888)834-3721		(866)242-7726		(866)242-7726		(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	1	1						06/03/2022	2023.01	06/03/2022 05:52:06 PM Eastern Daylight Time		06/03/2022 05:19:00 PM Eastern Daylight Time			06/03/2022 05:57:40 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	2023	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	2	1						06/03/2022	2023.01	06/03/2022 06:36:12 PM Eastern Daylight Time		06/03/2022 07:02:52 PM Eastern Daylight Time			06/03/2022 07:04:43 PM 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	2023	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	2	1						05/26/2022	2023.01	05/26/2022 12:50:34 PM Pacific Daylight Time		06/01/2022 06:24:38 PM Pacific Daylight Time			06/01/2022 06:36:12 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org/en/ForMembers/PACE	CalOptima PACE (PACE)	08	20		1			H7501	001	0	2023	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	2	1						05/26/2022	2023.01	05/26/2022 12:50:49 PM Pacific Daylight Time		06/01/2022 06:24:38 PM Pacific Daylight Time			06/01/2022 06:36:12 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org/en/ForMembers/PACE	CalOptima PACE (PACE)	08	20		1			H7501	002	0	2023	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	5	1		1				08/02/2022	2023.01	08/02/2022 08:09:59 PM Central Daylight Time	08/03/2022 11:45:54 AM Central Daylight Time	08/02/2022 11:28:06 AM Central Daylight Time			08/04/2022 12:49:43 PM 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	2023	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		(855)800-8872		(855)800-8872		(844)637-4760		(844)637-4760		(888)279-1549		(888)279-1549		(888)279-1549		(888)279-1549		(711)-		(711)-		(888)279-1549		(888)279-1549		2					2					2	2			
H7511	002	0	1	01	01	H7511_002_0	5	1		1				08/02/2022	2023.01	08/02/2022 08:09:31 PM Central Daylight Time	08/03/2022 11:46:30 AM Central Daylight Time	08/02/2022 11:29:34 AM Central Daylight Time			08/04/2022 12:49:43 PM 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	2023	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		(855)800-8872		(855)800-8872		(844)637-4760		(844)637-4760		(888)279-1549		(888)279-1549		(888)279-1549		(888)279-1549		(711)-		(711)-		(888)279-1549		(888)279-1549		2					2					2	2			
H7512	001	0	1	04	01	H7512_001_0	5	1						08/01/2022	2023.01	08/01/2022 12:56:16 PM Central Daylight Time	08/03/2022 08:56:19 PM Eastern Daylight Time	07/30/2022 10:25:52 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan Access Plus (PPO)	01	04		1			H7512	001	0	2023	Detroit Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7512	002	0	1	04	01	H7512_002_0	5	1						08/01/2022	2023.01	08/01/2022 12:57:15 PM Central Daylight Time	08/03/2022 08:57:32 PM Eastern Daylight Time	07/30/2022 10:26:24 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan Access (PPO)	01	04		1			H7512	002	0	2023	Detroit Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7512	003	0	1	04	01	H7512_003_0	5	1						08/01/2022	2023.01	08/01/2022 12:58:01 PM Central Daylight Time	08/03/2022 08:58:46 PM Eastern Daylight Time	07/30/2022 10:26:56 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan Access Plus (PPO)	01	04		1			H7512	003	0	2023	Select counties in Michigan		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7512	004	0	1	04	01	H7512_004_0	5	1						08/01/2022	2023.01	08/01/2022 12:59:45 PM Central Daylight Time	08/03/2022 09:00:00 PM Eastern Daylight Time	07/30/2022 10:27:29 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Michigan Access (PPO)	01	04		1			H7512	004	0	2023	Select counties in Michigan		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(833)431-1356		(833)431-1356		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7512	801	0	1	04	01	H7512_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:19:43 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H7512	801	0	2023	Detroit Area Counties		1	100	2			2									In development	In development	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:19:49 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H7512	802	0	2023	Detroit Area Counties		1	100	2			2									In development	In development	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:19:54 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H7512	803	0	2023	Detroit Area Counties		1	100	2			2									In development	In development	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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			2			08/01/2022	2023.01	08/01/2022 12:39:48 PM Eastern Daylight Time	08/03/2022 08:29:56 PM Eastern Daylight Time	07/30/2022 10:28:00 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select counties in MO		2		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	3	1			2	0	0	05/31/2022	2023.01	05/31/2022 11:41:09 AM Eastern Daylight Time	06/03/2022 08:29:32 PM Eastern Daylight Time				07/15/2022 03:54:34 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	2023	Select counties in MO		2		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	5	1	2	1	1		0	07/14/2022	2023.01	07/14/2022 04:42:49 PM Eastern Daylight Time	08/03/2022 08:31:36 PM Eastern Daylight Time	07/30/2022 10:28:33 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select counties in MO		2		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			2			08/01/2022	2023.01	08/01/2022 12:41:31 PM Eastern Daylight Time	08/03/2022 08:27:29 PM Eastern Daylight Time	07/30/2022 10:29:04 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select Counties in MO		2		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			2			06/02/2022	2023.01	06/02/2022 12:19:12 PM Eastern Daylight Time	08/03/2022 08:35:38 PM Eastern Daylight Time	07/30/2022 10:29:36 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select Counties in MO		2		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						05/31/2022	2023.01	05/31/2022 03:36:07 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group A Calendar (PPO)	01	04		1			H7522	801	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 11:17:22 AM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group B Calendar (PPO)	01	04		1			H7522	802	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;11a;11b;11c;	2		1									
H7522	804	0	1	04	01	H7522_804_0	3	1						05/18/2022	2023.01	05/18/2022 11:26:14 AM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group C Calendar (PPO)	01	04		1			H7522	804	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 11:35:33 AM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group D Calendar (PPO)	01	04		1			H7522	805	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;11a;11b;11c;	2		1									
H7522	806	0	1	04	01	H7522_806_0	3	1						05/18/2022	2023.01	05/18/2022 11:39:04 AM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group A Non-Calendar (PPO)	01	04		1			H7522	806	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 11:44:33 AM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group B Non-Calendar (PPO)	01	04		1			H7522	807	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 11:48:35 AM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group C Non-Calendar (PPO)	01	04		1			H7522	808	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 12:03:17 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group D Non-Calendar (PPO)	01	04		1			H7522	809	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 06:55:18 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group E Calendar (PPO)	01	04		1			H7522	810	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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						05/18/2022	2023.01	05/18/2022 01:32:23 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group E Non-Calendar (PPO)	01	04		1			H7522	811	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	812	0	1	04	01	H7522_812_0	3	1						05/18/2022	2023.01	05/18/2022 06:54:54 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group F Calendar (PPO)	01	04		1			H7522	812	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	813	0	1	04	01	H7522_813_0	3	1						05/18/2022	2023.01	05/18/2022 06:16:34 PM SA Western Standard Time					06/03/2022 08:24:07 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Mas	www.mmmpr.com	MMM Advantage Group F Non-Calendar (PPO)	01	04		1			H7522	813	0	2023	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7524	001	0	1	01	01	H7524_001_0	9	1	2	1			0	08/03/2022	2023.01	08/03/2022 10:49:33 AM Eastern Daylight Time	08/03/2022 01:48:24 PM Eastern Daylight Time	07/31/2022 12:03:14 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Excellus Health Plan Community Care LLC	www.UniveraMedicare.com	Univera Medicare Dual (HMO D-SNP)	01	01		1			H7524	001	0	2023	Western New York		2		2			1	3		1					1	www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(866)862-7087		(866)862-7087		(800)659-1986		(800)659-1986		(866)862-7087		(866)862-7087		(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			
H7524	002	0	1	01	01	H7524_002_0	9	1	2	1			0	08/03/2022	2023.01	08/03/2022 09:02:36 AM Eastern Daylight Time	08/03/2022 01:48:56 PM Eastern Daylight Time	07/31/2022 12:03:36 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Excellus Health Plan Community Care LLC	www.UniveraMedicare.com	Univera Medicare Total Care (HMO D-SNP)	01	01		1			H7524	002	0	2023	Western New York		2		2			1	3		1					1	www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(866)862-7087		(866)862-7087		(800)659-1986		(800)659-1986		(866)862-7087		(866)862-7087		(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			
H7524	003	0	1	01	01	H7524_003_0	9	1	2	1			0	08/03/2022	2023.01	08/03/2022 09:03:23 AM Eastern Daylight Time	08/03/2022 01:49:28 PM Eastern Daylight Time	07/31/2022 12:03:58 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Excellus Health Plan Community Care LLC	www.ExcellusMedicare.com	Medicare Blue Dual (HMO D-SNP)	01	01		1			H7524	003	0	2023	Rochester and Central New York Area		2		2			1	3		1					1	www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(866)862-7087		(866)862-7087		(800)659-1986		(800)659-1986		(866)862-7087		(866)862-7087		(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			
H7524	004	0	1	01	01	H7524_004_0	9	1	2	1			0	08/03/2022	2023.01	08/03/2022 09:04:04 AM Eastern Daylight Time	08/03/2022 01:49:58 PM Eastern Daylight Time	07/31/2022 12:04:20 PM Eastern Daylight Time			08/05/2022 12:53:28 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Excellus Health Plan Community Care LLC	www.ExcellusMedicare.com	Medicare Blue Dual Secure (HMO D-SNP)	01	01		1			H7524	004	0	2023	Rochester and Central New York Area		2		2			1	3		1					1	www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(866)862-7087		(866)862-7087		(800)659-1986		(800)659-1986		(866)862-7087		(866)862-7087		(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			
H7556	001	0	1	04	01	H7556_001_0	5	1						08/01/2022	2023.01	08/01/2022 01:01:49 PM Central Daylight Time	08/03/2022 09:01:14 PM Eastern Daylight Time	07/30/2022 10:30:08 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent's Access Plus (PPO)	01	04		1			H7556	001	0	2023	Birmingham & Surrounding  Counties in Alabama		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7556	002	0	1	04	01	H7556_002_0	5	1						08/01/2022	2023.01	08/01/2022 01:02:57 PM Central Daylight Time	08/03/2022 09:02:28 PM Eastern Daylight Time	07/30/2022 10:30:43 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent's Access (PPO)	01	04		1			H7556	002	0	2023	Birmingham & Surrounding  Counties in Alabama		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7556	003	0	1	04	01	H7556_003_0	5	1						08/01/2022	2023.01	08/01/2022 01:04:25 PM Central Daylight Time	08/03/2022 09:03:43 PM Eastern Daylight Time	07/30/2022 10:31:15 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Providence Access Plus (PPO)	01	04		1			H7556	003	0	2023	Mobile area in Alabama		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7556	004	0	1	04	01	H7556_004_0	6	1						08/01/2022	2023.01	08/01/2022 01:05:53 PM Central Daylight Time	08/03/2022 09:04:56 PM Eastern Daylight Time	07/30/2022 10:31:47 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Providence Access (PPO)	01	04		1			H7556	004	0	2023	Mobile area in Alabama		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(833)623-0771		(833)623-0771		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7557	001	0	1	01	01	H7557_001_0	10	1		1				08/04/2022	2023.01	08/04/2022 03:03:37 PM Central Daylight Time	08/04/2022 12:47:38 PM Central Daylight Time	08/02/2022 08:37:17 AM Central Daylight Time			08/04/2022 03:18:36 PM Central 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	2023	MI (Partial)		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	9	1	2	1			0	08/04/2022	2023.01	08/04/2022 12:54:00 PM Pacific Daylight Time	08/04/2022 06:10:42 PM Pacific Daylight Time	08/01/2022 10:44:56 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	Molina Healthcare of Virginia, LLC	Molina Healthcare of Virginia	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H7559	001	0	2023	Virginia		2		2			1	3		1					1	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)424-4495		(800)424-4495		(866)403-8293		(866)403-8293		(800)424-4495		(800)424-4495		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7559	002	0	1	01	01	H7559_002_0	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:36:27 PM Pacific Daylight Time	08/04/2022 06:11:10 PM Pacific Daylight Time	08/01/2022 10:45:28 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	Molina Healthcare of Virginia, LLC	Molina Healthcare of Virginia	www.molinahealthcare.com/medicare	Molina Medicare Complete Care Select (HMO D-SNP)	01	01		1			H7559	002	0	2023	Virginia		2		2			1	3		2					2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)424-4495		(800)424-4495		(866)403-8293		(866)403-8293		(800)424-4495		(800)424-4495		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7559	003	0	1	01	01	H7559_003_0	7	1					1	08/04/2022	2023.01	08/04/2022 05:36:44 PM Pacific Daylight Time	08/04/2022 06:11:40 PM Pacific Daylight Time	08/01/2022 10:46:02 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	Molina Healthcare of Virginia, LLC	Molina Healthcare of Virginia	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H7559	003	0	2023	Virginia		2		2			2									www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)424-4495		(800)424-4495		(866)403-8293		(866)403-8293		(800)424-4495		(800)424-4495		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7598	003	0	1	01	01	H7598_003_0	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 06:43:00 PM Central Daylight Time	08/04/2022 02:00:53 PM Central Daylight Time	08/04/2022 02:02:00 PM Central Daylight Time			08/05/2022 01:56:31 PM Central Daylight Time	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Group Health Cooperative of Eau Claire	www.group-health.com	Cooperative Advantage (HMO D-SNP)	01	01		1			H7598	003	0	2023	Wisconsin		2		2			1	3		1					2	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			
H7605	001	0	1	01	01	H7605_001_0	11	1			2		1	08/03/2022	2023.01	08/03/2022 03:27:45 PM US Eastern Daylight Time	08/04/2022 09:55:25 AM Eastern Daylight Time	07/31/2022 01:58:31 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TENNESSEE INC	Devoted Health	www.Devoted.com	Devoted CORE Tennessee (HMO)	01	01		1			H7605	001	0	2023	Knoxville		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			
H7605	002	0	1	01	01	H7605_002_0	12	1			2		0	08/03/2022	2023.01	08/03/2022 03:28:07 PM US Eastern Daylight Time	08/04/2022 09:55:50 AM Eastern Daylight Time	07/31/2022 01:58:52 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TENNESSEE INC	Devoted Health	www.Devoted.com	Devoted GIVEBACK Tennessee (HMO)	01	01		1			H7605	002	0	2023	Knoxville		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			
H7605	003	0	1	01	01	H7605_003_0	11	1			2		1	08/03/2022	2023.01	08/03/2022 03:28:27 PM US Eastern Daylight Time	08/04/2022 09:56:13 AM Eastern Daylight Time	07/31/2022 01:59:14 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TENNESSEE INC	Devoted Health	www.Devoted.com	Devoted PRIME Tennessee (HMO)	01	01		1			H7605	003	0	2023	Knoxville		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			
H7605	004	0	1	01	01	H7605_004_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 03:28:59 PM US Eastern Daylight Time	08/04/2022 09:56:38 AM Eastern Daylight Time	07/31/2022 01:59:35 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TENNESSEE INC	Devoted Health	www.Devoted.com	Devoted CORE Tennessee (HMO)	01	01		1			H7605	004	0	2023	Fayette, Shelby, Tipton 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			
H7605	005	0	1	01	01	H7605_005_0	11	1			2		0	08/03/2022	2023.01	08/03/2022 03:29:23 PM US Eastern Daylight Time	08/04/2022 09:57:03 AM Eastern Daylight Time	07/31/2022 01:59:57 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TENNESSEE INC	Devoted Health	www.Devoted.com	Devoted GIVEBACK Tennessee (HMO)	01	01		1			H7605	005	0	2023	Fayette, Shelby, Tipton 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			
H7605	006	0	1	01	01	H7605_006_0	10	1		1	1		0	08/03/2022	2023.01	08/03/2022 03:29:55 PM US Eastern Daylight Time	08/04/2022 09:57:28 AM Eastern Daylight Time	07/31/2022 02:00:18 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TENNESSEE INC	Devoted Health	www.Devoted.com	Devoted RESTORE PLUS Tennessee - D (HMO C-SNP)	01	01		1			H7605	006	0	2023	Nashville and Memphis		2		2			1	4			00000010000000000000000					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			
H7605	007	0	1	01	01	H7605_007_0	11	1			2		1	08/03/2022	2023.01	08/03/2022 03:30:11 PM US Eastern Daylight Time	08/04/2022 09:57:57 AM Eastern Daylight Time	07/31/2022 02:00:40 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TENNESSEE INC	Devoted Health	www.Devoted.com	Devoted CORE Tennessee (HMO)	01	01		1			H7605	007	0	2023	Nashville		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			
H7605	008	0	1	01	01	H7605_008_0	12	1			2		0	08/03/2022	2023.01	08/03/2022 03:30:29 PM US Eastern Daylight Time	08/04/2022 09:58:22 AM Eastern Daylight Time	07/31/2022 02:01:01 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TENNESSEE INC	Devoted Health	www.Devoted.com	Devoted GIVEBACK Tennessee (HMO)	01	01		1			H7605	008	0	2023	Nashville		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			
H7607	002	1	1	01	01	H7607_002_1	9	1					1	08/05/2022	2023.01	08/05/2022 10:08:38 AM Eastern Daylight Time	08/04/2022 04:22:18 PM Eastern Daylight Time	08/04/2022 06:22:50 PM Eastern Daylight Time			08/05/2022 11:30:07 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	2023	Southern California	Los Angeles County	2		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	9	1					1	08/05/2022	2023.01	08/05/2022 10:08:56 AM Eastern Daylight Time	08/04/2022 04:28:32 PM Eastern Daylight Time	08/04/2022 06:26:13 PM Eastern Daylight Time			08/05/2022 11:30:07 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	2023	Southern California	Orange County	2		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	9	1					1	08/05/2022	2023.01	08/05/2022 10:09:01 AM Eastern Daylight Time	08/04/2022 04:35:10 PM Eastern Daylight Time	08/04/2022 06:29:40 PM Eastern Daylight Time			08/05/2022 11:30:07 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	2023	Southern California	San Diego County	2		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	4	1	01	01	H7607_002_4	9	1					1	08/05/2022	2023.01	08/05/2022 10:09:05 AM Eastern Daylight Time	08/04/2022 04:42:20 PM Eastern Daylight Time	08/04/2022 06:33:03 PM Eastern Daylight Time			08/05/2022 11:30:07 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	4	2023	Southern California	San Bernardino County	2		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	5	1	01	01	H7607_002_5	9	1					1	08/05/2022	2023.01	08/05/2022 10:09:12 AM Eastern Daylight Time	08/04/2022 04:48:51 PM Eastern Daylight Time	08/04/2022 06:36:27 PM Eastern Daylight Time			08/05/2022 11:30:07 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	5	2023	Southern California	Riverside County	2		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	1	1	01	01	H7607_007_1	10	1					1	08/05/2022	2023.01	08/05/2022 10:09:37 AM Eastern Daylight Time	08/04/2022 04:55:46 PM Eastern Daylight Time	08/04/2022 06:39:49 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Fortune Medicare Advantage (HMO)	01	01		1			H7607	007	1	2023	Southern California	Los Angeles County	2		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	10	1					1	08/05/2022	2023.01	08/05/2022 10:09:54 AM Eastern Daylight Time	08/04/2022 05:01:57 PM Eastern Daylight Time	08/04/2022 06:43:10 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Fortune Medicare Advantage (HMO)	01	01		1			H7607	007	2	2023	Southern California	Orange County	2		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	10	1					1	08/05/2022	2023.01	08/05/2022 10:10:00 AM Eastern Daylight Time	08/04/2022 05:08:59 PM Eastern Daylight Time	08/04/2022 06:46:36 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Fortune Medicare Advantage (HMO)	01	01		1			H7607	007	3	2023	Southern California	San Diego County	2		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	4	1	01	01	H7607_007_4	10	1					1	08/05/2022	2023.01	08/05/2022 10:10:05 AM Eastern Daylight Time	08/04/2022 05:16:18 PM Eastern Daylight Time	08/04/2022 06:50:02 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Fortune Medicare Advantage (HMO)	01	01		1			H7607	007	4	2023	Southern California	San Bernardino County	2		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	5	1	01	01	H7607_007_5	10	1					1	08/05/2022	2023.01	08/05/2022 10:10:10 AM Eastern Daylight Time	08/04/2022 05:22:40 PM Eastern Daylight Time	08/04/2022 06:53:29 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Fortune Medicare Advantage (HMO)	01	01		1			H7607	007	5	2023	Southern California	Riverside County	2		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	10	1					1	08/05/2022	2023.01	08/05/2022 10:10:24 AM Eastern Daylight Time	08/04/2022 05:29:16 PM Eastern Daylight Time	08/04/2022 06:56:50 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Value Medicare Advantage (HMO)	01	01		1			H7607	008	1	2023	Southern California	Los Angeles County	2		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	10	1					1	08/05/2022	2023.01	08/05/2022 10:10:46 AM Eastern Daylight Time	08/04/2022 05:34:22 PM Eastern Daylight Time	08/04/2022 07:00:11 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Value Medicare Advantage (HMO)	01	01		1			H7607	008	2	2023	Southern California	Orange County	2		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	10	1					1	08/05/2022	2023.01	08/05/2022 10:10:52 AM Eastern Daylight Time	08/04/2022 05:39:28 PM Eastern Daylight Time	08/04/2022 07:03:31 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Value Medicare Advantage (HMO)	01	01		1			H7607	008	3	2023	Southern California	San Diego County	2		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	4	1	01	01	H7607_008_4	10	1					1	08/05/2022	2023.01	08/05/2022 10:10:57 AM Eastern Daylight Time	08/04/2022 05:44:32 PM Eastern Daylight Time	08/04/2022 07:06:52 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Value Medicare Advantage (HMO)	01	01		1			H7607	008	4	2023	Southern California	San Bernardino County	2		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	5	1	01	01	H7607_008_5	10	1					1	08/05/2022	2023.01	08/05/2022 10:11:03 AM Eastern Daylight Time	08/04/2022 05:49:39 PM Eastern Daylight Time	08/04/2022 07:10:20 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Value Medicare Advantage (HMO)	01	01		1			H7607	008	5	2023	Southern California	Riverside County	2		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	011	1	1	01	01	H7607_011_1	9	1		1			1	08/05/2022	2023.01	08/05/2022 10:11:14 AM Eastern Daylight Time	08/04/2022 05:54:42 PM Eastern Daylight Time	08/04/2022 07:13:50 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Jasmine Medicare Advantage (HMO C-SNP)	01	01		1			H7607	011	1	2023	Southern California	Los Angeles County	2		2			1	4			00000000000000001000000					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	011	2	1	01	01	H7607_011_2	9	1		1			1	08/05/2022	2023.01	08/05/2022 10:11:32 AM Eastern Daylight Time	08/04/2022 05:59:45 PM Eastern Daylight Time	08/04/2022 07:17:19 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Jasmine Medicare Advantage (HMO C-SNP)	01	01		1			H7607	011	2	2023	Southern California	Orange County	2		2			1	4			00000000000000001000000					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	011	4	1	01	01	H7607_011_4	9	1		1			1	08/05/2022	2023.01	08/05/2022 10:11:37 AM Eastern Daylight Time	08/04/2022 06:04:50 PM Eastern Daylight Time	08/04/2022 07:20:41 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Jasmine Medicare Advantage (HMO C-SNP)	01	01		1			H7607	011	4	2023	Southern California	San Bernardino County	2		2			1	4			00000000000000001000000					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	011	5	1	01	01	H7607_011_5	8	1		1			1	08/05/2022	2023.01	08/05/2022 10:11:42 AM Eastern Daylight Time	08/04/2022 06:10:00 PM Eastern Daylight Time	08/04/2022 07:24:02 PM Eastern Daylight Time			08/05/2022 11:30:07 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Jasmine Medicare Advantage (HMO C-SNP)	01	01		1			H7607	011	5	2023	Southern California	Riverside County	2		2			1	4			00000000000000001000000					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	801	0	1	04	01	H7617_801_0	6	1						05/27/2022	2023.01	05/27/2022 12:24:42 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	801	0	2023	Select Counties in Multi-States		1	89704	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:25:06 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	802	0	2023	Select Counties in Multi-States		1	34377	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:25:27 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H7617	803	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:25:47 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H7617	804	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:26:05 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	805	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	9	1				0	0	06/01/2022	2023.01	06/01/2022 10:40:45 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	806	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:26:47 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	807	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:27:08 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	808	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:27:27 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	809	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:27:44 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	810	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						05/27/2022	2023.01	05/27/2022 12:28:00 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	811	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1				0	0	05/27/2022	2023.01	05/27/2022 12:28:20 PM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	812	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	813	0	1	04	01	H7617_813_0	4	1						05/31/2022	2023.01	05/31/2022 10:38:29 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	813	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	814	0	1	04	01	H7617_814_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 10:36:00 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	814	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	815	0	1	04	01	H7617_815_0	4	1						05/31/2022	2023.01	05/31/2022 10:35:39 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	815	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	816	0	1	04	01	H7617_816_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 10:38:15 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	816	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	817	0	1	04	01	H7617_817_0	4	1						05/31/2022	2023.01	05/31/2022 10:40:17 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	817	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	818	0	1	04	01	H7617_818_0	4	1				0	0	05/31/2022	2023.01	05/31/2022 10:42:09 AM Eastern Daylight Time					06/02/2022 05:55:36 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	818	0	2023	Select Counties in Multi-States		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						06/01/2022	2023.01	06/01/2022 01:08:03 PM Eastern Daylight Time		05/27/2022 10:21:53 AM Eastern Daylight Time			06/01/2022 01:11:15 PM 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	2023	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						06/01/2022	2023.01	06/01/2022 01:08:55 PM Eastern Daylight Time		05/27/2022 10:21:44 AM Eastern Daylight Time			06/01/2022 01:11:15 PM 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	2023	Counties: Atlantic, Cape May		2		2			2									NA	NA										(888)569-1000		(609)407-2052		(888)569-1000		(609)407-2052												(800)852-7899				(800)852-7899																
H7621	001	0	1	01	01	H7621_001_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 12:38:57 PM Eastern Daylight Time	08/03/2022 03:43:47 PM Eastern Daylight Time	07/30/2022 09:48:20 AM Eastern Daylight Time			08/04/2022 10:57:40 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H7621	001	0	2023	Select Counties in Kansas City Metro area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:04:07 AM Eastern Daylight Time	08/03/2022 04:12:18 PM Eastern Daylight Time	07/30/2022 09:48:46 AM Eastern Daylight Time			08/04/2022 01:20:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H7621	002	0	2023	Riverside and San Bernardino counties		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 11:04:25 AM Eastern Daylight Time	08/03/2022 04:14:16 PM Eastern Daylight Time	07/30/2022 09:49:12 AM Eastern Daylight Time			08/04/2022 01:20:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H7621	003	0	2023	San Joaquin County		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/03/2022	2023.01	08/03/2022 09:45:00 AM Central Daylight Time	08/03/2022 09:43:17 AM Central Daylight Time	08/03/2022 09:41:38 AM Central Daylight Time			08/04/2022 09:32:25 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.sparrowadvantage.com	Sparrow Advantage (HMO-POS)	01	02		1			H7646	001	0	2023	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	08/03/2022	2023.01	08/03/2022 09:45:18 AM Central Daylight Time	08/03/2022 09:55:04 AM Central Daylight Time	08/03/2022 10:10:38 AM Central Daylight Time			08/04/2022 09:32:25 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.covenantadvantage.com	Covenant Advantage (HMO-POS)	01	02		1			H7646	002	0	2023	Bay, Huron, Saginaw, Sanilac, 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	7	1					1	08/03/2022	2023.01	08/03/2022 09:45:39 AM Central Daylight Time	08/04/2022 10:59:33 AM Central Daylight Time	08/03/2022 10:43:50 AM Central Daylight Time			08/04/2022 11:15:10 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpadvantage.com	PHP Advantage (HMO-POS)	01	02		1			H7646	003	0	2023	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	5	1					1	08/03/2022	2023.01	08/03/2022 09:45:58 AM Central Daylight Time	08/03/2022 10:46:13 AM Central Daylight Time	08/03/2022 10:49:11 AM Central Daylight Time			08/04/2022 09:32:25 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.sparrowadvantage.com	Sparrow Advantage Plus (HMO-POS)	01	02		1			H7646	004	0	2023	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	6	1					1	08/03/2022	2023.01	08/03/2022 09:46:22 AM Central Daylight Time	08/03/2022 10:57:19 AM Central Daylight Time	08/03/2022 11:00:23 AM Central Daylight Time			08/04/2022 09:32:25 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.covenantadvantage.com	Covenant Advantage Plus (HMO-POS)	01	02		1			H7646	005	0	2023	Bay, Huron, Saginaw, Sanilac, 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	6	1					1	08/03/2022	2023.01	08/03/2022 09:46:46 AM Central Daylight Time	08/03/2022 11:06:15 AM Central Daylight Time	08/03/2022 11:10:22 AM Central Daylight Time			08/04/2022 09:32:25 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpadvantage.com	PHP Advantage Plus (HMO-POS)	01	02		1			H7646	006	0	2023	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	6	1					1	08/03/2022	2023.01	08/03/2022 09:47:08 AM Central Daylight Time	08/03/2022 01:10:16 PM Central Daylight Time	08/03/2022 01:08:22 PM Central Daylight Time			08/04/2022 09:32:25 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	University of Michigan Health Advantage (HMO-POS)	01	02		1			H7646	007	0	2023	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	7	1					1	08/03/2022	2023.01	08/03/2022 09:47:26 AM Central Daylight Time	08/03/2022 01:21:05 PM Central Daylight Time	08/03/2022 01:19:45 PM Central Daylight Time			08/04/2022 09:32:25 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	University of Michigan Health Advantage Plus (HMO-POS)	01	02		1			H7646	008	0	2023	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	1	1						04/29/2022	2023.01	04/29/2022 12:00:10 PM Central Daylight Time					06/02/2022 03:41:48 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	EGWP MAPD Calendar year (HMO-POS)	01	02		1			H7646	801	0	2023	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;18a;	1				
H7646	802	0	1	02	01	H7646_802_0	1	1						04/29/2022	2023.01	04/29/2022 12:01:31 PM Central Daylight Time					06/02/2022 03:41:48 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	EGWP MAPD Non-Calendar year (HMO-POS)	01	02		1			H7646	802	0	2023	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;18a;	1				
H7646	803	0	1	02	01	H7646_803_0	1	1				0	0	04/29/2022	2023.01	04/29/2022 12:03:05 PM Central Daylight Time					06/02/2022 03:41:48 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	EGWP MA Only Calendar Year (HMO-POS)	01	02		1			H7646	803	0	2023	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;	1				
H7646	804	0	1	02	01	H7646_804_0	1	1				0	0	04/29/2022	2023.01	04/29/2022 12:04:20 PM Central Daylight Time					06/02/2022 03:41:48 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	EGWP MA Only non-Calendar Year (HMO-POS)	01	02		1			H7646	804	0	2023	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;18a;	1				
H7660	001	0	1	20	08	H7660_001_0	1	1						06/02/2022	2023.01	06/02/2022 04:52:37 PM Eastern Daylight Time		06/03/2022 09:09:45 AM Eastern Daylight Time			06/03/2022 09:17:03 AM Eastern Daylight Time	VIECARE BEAVER, LLC	LIFE Beaver and Lawrence Counties	http://www.lutheranseniorlife.org	VieCare Beaver, LLC dba LIFE Beaver and Lawrence C (PACE)	08	20		1			H7660	001	0	2023	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						06/02/2022	2023.01	06/02/2022 04:52:53 PM Eastern Daylight Time		06/03/2022 09:09:48 AM Eastern Daylight Time			06/03/2022 09:17:03 AM Eastern Daylight Time	VIECARE BEAVER, LLC	LIFE Beaver and Lawrence Counties	www.LutheranSeniorLife.org	VieCare Beaver, LLC dba LIFE Beaver and Lawrence C (PACE)	08	20		1			H7660	002	0	2023	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	7	1					1	08/05/2022	2023.01	08/05/2022 09:39:43 AM Eastern Daylight Time	08/05/2022 10:02:03 AM Eastern Daylight Time	08/04/2022 08:38:16 PM Eastern Daylight Time			08/05/2022 12:24:23 PM Eastern Daylight Time	CENTRAL MASS HEALTH, LLC	Mass Advantage	https://www.massadvantage.com	Mass Advantage Basic (HMO)	01	01		1			H7670	001	0	2023	Massachusetts (Partial)		2		2			2									https://www.massadvantage.com	https://www.massadvantage.com	https://www.massadvantage.com	(844)918-0114		(844)918-0114		(844)514-0674		(844)514-0674		(844)918-0114		(844)918-0114		(844)514-0674		(844)514-0674		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7670	002	0	1	01	01	H7670_002_0	7	1					1	08/05/2022	2023.01	08/05/2022 09:39:32 AM Eastern Daylight Time	08/05/2022 10:02:38 AM Eastern Daylight Time	08/04/2022 08:38:54 PM Eastern Daylight Time			08/05/2022 12:24:23 PM Eastern Daylight Time	CENTRAL MASS HEALTH, LLC	Mass Advantage	https://www.massadvantage.com	Mass Advantage Plus (HMO)	01	01		1			H7670	002	0	2023	Massachusetts (Partial)		2		2			2									https://www.massadvantage.com	https://www.massadvantage.com	https://www.massadvantage.com	(844)918-0114		(844)918-0114		(844)514-0674		(844)514-0674		(844)918-0114		(844)918-0114		(844)514-0674		(844)514-0674		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7678	001	0	1	01	01	H7678_001_0	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:46:30 PM Pacific Daylight Time	08/04/2022 06:12:08 PM Pacific Daylight Time	08/01/2022 10:46:34 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	8	1		1				08/04/2022	2023.01	08/04/2022 05:37:04 PM Pacific Daylight Time	08/04/2022 06:12:36 PM Pacific Daylight Time	08/01/2022 10:47:10 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	Dallas County		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	7	1					1	08/04/2022	2023.01	08/04/2022 05:46:52 PM Pacific Daylight Time	08/04/2022 06:13:06 PM Pacific Daylight Time	08/01/2022 10:47:42 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	9	1					1	08/04/2022	2023.01	08/04/2022 01:10:01 PM Pacific Daylight Time	08/04/2022 06:13:34 PM Pacific Daylight Time	08/01/2022 03:32:30 PM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	5	1			2		1	08/03/2022	2023.01	08/03/2022 12:02:41 PM Pacific Daylight Time	08/03/2022 03:45:25 PM Pacific Daylight Time	08/03/2022 03:45:25 PM Pacific Daylight Time			08/03/2022 03:57:19 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H7680	001	0	2023	Potter,Gray,Moore,DS,Cooke,Fannin,Grayson,Randall		2		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	5	1			1		1	08/03/2022	2023.01	08/03/2022 12:03:28 PM Pacific Daylight Time	08/03/2022 03:45:25 PM Pacific Daylight Time	08/03/2022 03:45:25 PM Pacific Daylight Time			08/03/2022 03:57:19 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H7680	002	0	2023	South Texas		2		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	4	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 01:23:00 PM Pacific Daylight Time	08/03/2022 03:45:26 PM Pacific Daylight Time	08/03/2022 03:45:26 PM Pacific Daylight Time			08/03/2022 03:57:19 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	2023	South Texas		2		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	1	1				0	0	05/02/2022	2023.01	05/02/2022 10:55:48 PM Pacific Daylight Time					06/02/2022 11:44:26 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H7680	801	0	2023	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	07/11/2022	2023.01	07/11/2022 10:26:26 AM Eastern Daylight Time	08/04/2022 06:18:09 PM Eastern Daylight Time	08/04/2022 06:32:39 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	005	0	1	04	01	H7728_005_0	6	1			2		1	06/01/2022	2023.01	06/01/2022 10:22:41 AM Eastern Daylight Time	08/04/2022 06:21:30 PM Eastern Daylight Time	08/04/2022 06:39:03 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	6	1			2		1	06/01/2022	2023.01	06/01/2022 10:20:29 AM Eastern Daylight Time	08/04/2022 06:21:32 PM Eastern Daylight Time	08/04/2022 06:39:06 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	5	1			2		1	05/24/2022	2023.01	05/24/2022 11:45:02 AM Eastern Daylight Time	08/04/2022 06:17:17 PM Eastern Daylight Time	08/04/2022 06:31:01 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1			2		0	08/04/2022	2023.01	08/04/2022 02:08:11 PM Eastern Daylight Time	08/04/2022 06:18:11 PM Eastern Daylight Time	08/04/2022 06:32:42 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	6	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 11:22:40 AM Eastern Daylight Time	08/04/2022 06:21:33 PM Eastern Daylight Time	08/04/2022 06:39:08 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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		1	08/01/2022	2023.01	08/01/2022 02:38:26 PM Eastern Daylight Time	08/04/2022 06:21:34 PM Eastern Daylight Time	08/04/2022 06:39:11 PM Eastern Daylight Time			08/04/2022 07:09:53 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	2023	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	013	0	1	04	01	H7728_013_0	5	1			2		0	05/24/2022	2023.01	05/24/2022 11:08:31 AM Eastern Daylight Time	08/04/2022 06:17:19 PM Eastern Daylight Time	08/04/2022 06:31:04 PM Eastern Daylight Time			08/04/2022 09:35:16 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	013	0	2023	Select counties in KY		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	801	0	1	04	01	H7728_801_0	2	1						05/23/2022	2023.01	05/23/2022 03:12:55 PM Pacific Daylight Time					06/03/2022 10:38:15 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	2023	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;15;16b;18a;	2		1									
H7728	802	0	1	04	01	H7728_802_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 03:13:01 PM Pacific Daylight Time					06/03/2022 10:38:15 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	2023	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;15;16b;18a;	2		1									
H7746	001	0	1	01	01	H7746_001_0	7	1					1	08/02/2022	2023.01	08/02/2022 02:59:59 PM Eastern Daylight Time	08/04/2022 08:56:04 AM Eastern Daylight Time	08/03/2022 10:52:40 AM Eastern Daylight Time			08/04/2022 08:34:44 PM Eastern Daylight Time	MDWISE, INC	MDwise Medicare	www.mdwise.org/medicare	MDwise Medicare Inspire (HMO)	01	01		1			H7746	001	0	2023	Select Mid-Indiana Counties		2		2			2									www.mdwise.org	www.mdwise.org/medicare	www.mdwise.org/medicare	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(800)910-4691		(317)822-7401		(833)358-2140		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7746	002	0	1	01	01	H7746_002_0	7	1					1	08/02/2022	2023.01	08/02/2022 03:09:25 PM Eastern Daylight Time	08/04/2022 08:57:14 AM Eastern Daylight Time	08/03/2022 10:54:16 AM Eastern Daylight Time			08/04/2022 08:34:44 PM Eastern Daylight Time	MDWISE, INC	MDwise Medicare	www.mdwise.org/medicare	MDwise Medicare Inspire Plus (HMO)	01	01		1			H7746	002	0	2023	Select Mid-Indiana Counties		2		2			2									www.mdwise.org	www.mdwise.org/medicare	www.mdwise.org/medicare	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(800)910-4691		(317)822-7401		(833)358-2140		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7746	003	0	1	02	01	H7746_003_0	7	1					1	08/02/2022	2023.01	08/02/2022 03:22:19 PM Eastern Daylight Time	08/04/2022 08:58:26 AM Eastern Daylight Time	08/03/2022 10:56:08 AM Eastern Daylight Time			08/04/2022 08:34:44 PM Eastern Daylight Time	MDWISE, INC	MDwise Medicare	www.mdwise.org/medicare	MDwise Medicare Inspire Flex (HMO-POS)	01	02		1			H7746	003	0	2023	Select Mid-Indiana Counties		2		2			2									www.mdwise.org	www.mdwise.org/medicare	www.mdwise.org/medicare	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(800)910-4691		(317)822-7401		(833)358-2140		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7746	004	0	1	01	01	H7746_004_0	7	1	2	1			0	06/27/2022	2023.01	06/27/2022 01:49:56 PM Eastern Daylight Time	08/04/2022 08:59:30 AM Eastern Daylight Time	08/03/2022 10:57:36 AM Eastern Daylight Time			08/04/2022 08:34:44 PM Eastern Daylight Time	MDWISE, INC	MDwise Medicare	www.mdwise.org/medicare	MDwise Medicare Inspire Duals (HMO D-SNP)	01	01		1			H7746	004	0	2023	Select Mid-Indiana Counties DSNP		2		2			1	3		1					1	www.mdwise.org	www.mdwise.org/medicare	www.mdwise.org/medicare	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(800)910-4691		(317)822-7401		(833)358-2140		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7778	001	0	1	02	01	H7778_001_0	5	1	2	1	1		0	09/12/2022	2023.01	09/12/2022 09:11:45 AM Central Daylight Time	08/03/2022 04:40:18 PM Central Daylight Time	08/01/2022 12:38:24 PM Central Daylight Time			09/12/2022 10:36:56 AM Central Daylight Time	UNITEDHEALTHCARE OF ILLINOIS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H7778	001	0	2023	Select Counties in Minnesota		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			
H7778	002	0	1	02	01	H7778_002_0	6	1	2	1	1		0	09/12/2022	2023.01	09/12/2022 09:50:30 AM Central Daylight Time	08/03/2022 04:41:39 PM Central Daylight Time	08/01/2022 12:39:40 PM Central Daylight Time			09/12/2022 10:36:56 AM Central Daylight Time	UNITEDHEALTHCARE OF ILLINOIS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO-POS D-SNP)	01	02		1			H7778	002	0	2023	Select Counties in Minnesota		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			
H7779	001	0	1	01	01	H7779_001_0	5	1		1				08/02/2022	2023.01	08/02/2022 12:10:42 PM Central Daylight Time	08/01/2022 11:10:30 PM Central Daylight Time	07/29/2022 05:30:47 PM Central Daylight Time			08/03/2022 09:32:37 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	2023	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	1	01	7c;7i;	
H7787	001	0	1	04	01	H7787_001_0	4	1					1	08/03/2022	2023.01	08/03/2022 09:27:32 AM Central Daylight Time	08/03/2022 09:05:03 AM Central Daylight Time	08/01/2022 11:29:52 AM Central Daylight Time			08/04/2022 02:24:47 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (PPO)	01	04		1			H7787	001	0	2023	Dallas		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7787	002	0	1	04	01	H7787_002_0	3	1				0	0	07/18/2022	2023.01	07/18/2022 02:36:55 PM Central Daylight Time	05/31/2022 02:20:33 PM Central Daylight Time				07/18/2022 04:55:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Courage Medicare (PPO)	01	04		1			H7787	002	0	2023	Dallas		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7787	801	0	1	04	01	H7787_801_0	3	1						06/15/2022	2023.01	06/15/2022 04:09:34 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7787	801	0	2023	Nationwide		1	29652	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	802	0	1	04	01	H7787_802_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:53:09 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7787	802	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	803	0	1	04	01	H7787_803_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:52:56 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7787	803	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	804	0	1	04	01	H7787_804_0	2	1						05/22/2022	2023.01	05/22/2022 07:52:42 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7787	804	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	805	0	1	04	01	H7787_805_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:52:30 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Savings Medicare (PPO)	01	04		1			H7787	805	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	806	0	1	04	01	H7787_806_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:52:19 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Savings Medicare (PPO)	01	04		1			H7787	806	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	807	0	1	04	01	H7787_807_0	2	1						05/22/2022	2023.01	05/22/2022 07:52:06 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7787	807	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	808	0	1	04	01	H7787_808_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:51:43 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Savings Medicare (PPO)	01	04		1			H7787	808	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	809	0	1	04	01	H7787_809_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:51:32 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Savings Medicare (PPO)	01	04		1			H7787	809	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	810	0	1	04	01	H7787_810_0	2	1						05/22/2022	2023.01	05/22/2022 07:51:18 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7787	810	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	811	0	1	04	01	H7787_811_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:51:06 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Savings Medicare (PPO)	01	04		1			H7787	811	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	812	0	1	04	01	H7787_812_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:50:53 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Savings Medicare (PPO)	01	04		1			H7787	812	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	813	0	1	04	01	H7787_813_0	2	1						05/22/2022	2023.01	05/22/2022 07:50:39 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7787	813	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	814	0	1	04	01	H7787_814_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:50:22 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Savings Medicare (PPO)	01	04		1			H7787	814	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7787	815	0	1	04	01	H7787_815_0	2	1				0	0	05/22/2022	2023.01	05/22/2022 07:50:08 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna True Choice Core Savings Medicare (PPO)	01	04		1			H7787	815	0	2023	Nationwide		1	600	2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7813	001	0	1	01	01	H7813_001_0	9	1	2	1			0	08/08/2022	2023.01	08/08/2022 12:35:43 PM Eastern Daylight Time	08/04/2022 11:41:40 AM Eastern Daylight Time	08/04/2022 11:41:40 AM Eastern Daylight Time			08/08/2022 12:36:29 PM Eastern Daylight Time	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	iCircle Services of the Finger Lakes, Inc	https://icirclecny.org/	iCircle Dual Advantage (HMO D-SNP)	01	01		1			H7813	001	0	2023	Finger Lakes, Southern Tier, Central, Western NY		2		2			1	3		1					1	https://icirclecny.org/	https://icirclecny.org/	https://icirclecny.org/	(844)424-7253		(844)424-7253		(844)424-7253		(844)424-7253		(844)424-7253		(844)424-7253		(844)424-7253		(844)424-7253		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7831	001	0	1	20	08	H7831_001_0	1	1						06/02/2022	2023.01	06/02/2022 12:50:53 PM Central Daylight Time		06/02/2022 01:02:38 PM Central Daylight Time			06/02/2022 01:06:00 PM Central Daylight Time	PRIME ACQUISITIONS, LLC	New Horizons PACE	christianhorizonsliving.org	New Horizons PACE (PACE)	08	20		1			H7831	001	0	2023	St. Louis City, MO and St. Louis, MO		2		2			2									na	na										(833)654-7223		(314)897-7223		(833)654-7223		(314)897-7223										(711)-		(711)-		(711)-		(711)-																
H7831	002	0	1	20	08	H7831_002_0	1	1						06/02/2022	2023.01	06/02/2022 12:51:16 PM Central Daylight Time		06/02/2022 01:02:38 PM Central Daylight Time			06/02/2022 01:06:00 PM Central Daylight Time	PRIME ACQUISITIONS, LLC	New Horizons PACE	christianhorizonsliving.org	New Horizons PACE (PACE)	08	20		1			H7831	002	0	2023	St. Louis City, MO and St. Louis, MO		2		2			2									na	na										(833)654-7223		(314)897-7223		(833)654-7223		(314)897-7223										(711)-		(711)-		(711)-		(711)-																
H7833	001	0	1	48	05	H7833_001_0	4	1						09/07/2022	2023.01	09/07/2022 10:27:55 AM Central Daylight Time					09/07/2022 10:28:54 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	2023	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	5	1						05/31/2023	2023.01	05/31/2023 03:29:52 PM Eastern Daylight Time					05/31/2023 03:31:10 PM Eastern 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	2023	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		(844)247-0578		(844)247-0578		(855)735-5604		(855)735-5604		(844)247-0578		(844)247-0578		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H7849	001	0	1	04	01	H7849_001_0	5	1					1	08/02/2022	2023.01	08/02/2022 06:59:55 PM Central Daylight Time	08/02/2022 11:27:02 AM Central Daylight Time	08/01/2022 11:30:23 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	001	0	2023	Denver		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	002	0	1	04	01	H7849_002_0	5	1					1	08/02/2022	2023.01	08/02/2022 06:04:13 PM Central Daylight Time	08/03/2022 05:01:24 PM Central Daylight Time	08/01/2022 11:30:55 AM Central Daylight Time			08/05/2022 08:36:58 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	002	0	2023	Chicago		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	003	0	1	04	01	H7849_003_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:23:01 PM Central Daylight Time	08/02/2022 09:43:28 PM Central Daylight Time	08/01/2022 11:31:26 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Metro Georgia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	006	0	1	04	01	H7849_006_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:38:51 PM Central Daylight Time	08/02/2022 01:42:27 PM Central Daylight Time	08/01/2022 11:31:58 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Philadelphia		2		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			
H7849	008	0	1	04	01	H7849_008_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:56:27 PM Central Daylight Time	08/02/2022 04:11:35 PM Central Daylight Time	08/01/2022 11:32:29 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Washington DC/Delaware		2		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			
H7849	010	0	1	04	01	H7849_010_0	4	1					1	08/04/2022	2023.01	08/04/2022 12:48:52 PM Central Daylight Time	08/02/2022 01:02:24 PM Central Daylight Time	08/01/2022 11:33:00 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	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					1	08/02/2022	2023.01	08/02/2022 04:45:15 PM Central Daylight Time	08/02/2022 12:21:02 PM Central Daylight Time	08/01/2022 11:33:31 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	011	0	2023	Triad		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	012	0	1	04	01	H7849_012_0	4	1					1	08/02/2022	2023.01	08/02/2022 04:28:02 PM Central Daylight Time	08/02/2022 07:50:20 PM Central Daylight Time	08/01/2022 11:34:03 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	012	0	2023	Huntsville		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	013	0	1	04	01	H7849_013_0	4	1					1	08/02/2022	2023.01	08/02/2022 04:28:58 PM Central Daylight Time	08/02/2022 07:52:05 PM Central Daylight Time	08/01/2022 11:34:34 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	013	0	2023	Birmingham/Mobile/Montgomery		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	014	0	1	04	01	H7849_014_0	4	1					1	08/04/2022	2023.01	08/04/2022 12:49:23 PM Central Daylight Time	08/03/2022 09:38:15 AM Central Daylight Time	08/01/2022 11:35:06 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Treasure Coast		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	015	0	1	04	01	H7849_015_0	5	1					1	08/02/2022	2023.01	08/02/2022 07:30:35 PM Central Daylight Time	08/03/2022 05:03:19 PM Central Daylight Time	08/01/2022 11:35:37 AM Central Daylight Time			08/05/2022 08:36:58 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	015	0	2023	Cleveland/Youngston		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)641-4017		(855)641-4017		(800)668-3813		(800)668-3813		(855)641-4017		(855)641-4017		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	016	0	1	04	01	H7849_016_0	4	1					1	08/02/2022	2023.01	08/02/2022 04:30:06 PM Central Daylight Time	08/02/2022 04:33:13 PM Central Daylight Time	08/01/2022 11:36:08 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	South Mississippi		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	017	0	1	04	01	H7849_017_0	5	1					1	08/02/2022	2023.01	08/02/2022 05:09:52 PM Central Daylight Time	08/02/2022 02:53:35 PM Central Daylight Time	08/01/2022 11:36:39 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Orlando		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	018	0	1	04	01	H7849_018_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:22:54 PM Central Daylight Time	08/02/2022 12:21:45 PM Central Daylight Time	08/01/2022 11:37:11 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Greenville/Spartanburg		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	019	0	1	04	01	H7849_019_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:23:46 PM Central Daylight Time	08/02/2022 12:22:19 PM Central Daylight Time	08/01/2022 11:37:42 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Charlotte/Triad/Asheville		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	020	0	1	04	01	H7849_020_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:25:17 PM Central Daylight Time	08/02/2022 04:02:46 PM Central Daylight Time	08/01/2022 11:38:13 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	020	0	2023	West Metro Georgia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	021	0	1	04	01	H7849_021_0	5	1					1	08/03/2022	2023.01	08/03/2022 08:03:19 AM Central Daylight Time	08/03/2022 02:17:00 PM Central Daylight Time	08/01/2022 11:38:44 AM Central Daylight Time			08/05/2022 08:36:58 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	2023	Athens		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	022	0	1	04	01	H7849_022_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:27:38 PM Central Daylight Time	08/02/2022 04:04:11 PM Central Daylight Time	08/01/2022 11:39:15 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	022	0	2023	Northeast Georgia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	023	0	1	04	01	H7849_023_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:28:36 PM Central Daylight Time	08/02/2022 04:05:09 PM Central Daylight Time	08/01/2022 11:39:47 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	023	0	2023	Northwest Georgia		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	024	0	1	04	01	H7849_024_0	5	1						08/02/2022	2023.01	08/02/2022 05:47:41 PM Central Daylight Time	08/03/2022 05:09:28 PM Central Daylight Time	08/01/2022 11:40:17 AM Central Daylight Time			08/05/2022 08:36:58 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	024	0	2023	Kansas City		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)612-0287		(866)612-0287		(800)668-3813		(800)668-3813		(866)612-0287		(866)612-0287		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	026	0	1	04	01	H7849_026_0	5	1					1	08/02/2022	2023.01	08/02/2022 07:00:34 PM Central Daylight Time	08/02/2022 11:28:35 AM Central Daylight Time	08/01/2022 11:40:48 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	026	0	2023	Fort Collins		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	027	0	1	04	01	H7849_027_0	5	1					1	08/02/2022	2023.01	08/02/2022 07:01:09 PM Central Daylight Time	08/02/2022 11:29:52 AM Central Daylight Time	08/01/2022 11:41:20 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	027	0	2023	Colorado Springs		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	028	0	1	04	01	H7849_028_0	5	1					1	08/02/2022	2023.01	08/02/2022 07:04:50 PM Central Daylight Time	08/02/2022 11:31:39 AM Central Daylight Time	08/01/2022 11:41:51 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	028	0	2023	Albuquerque		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)333-7640		(866)333-7640		(800)668-3813		(800)668-3813		(866)333-7640		(866)333-7640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	029	0	1	04	01	H7849_029_0	5	1					1	08/02/2022	2023.01	08/02/2022 07:05:50 PM Central Daylight Time	08/02/2022 11:33:18 AM Central Daylight Time	08/01/2022 11:42:22 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	029	0	2023	Salt Lake City		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)624-0168		(866)624-0168		(800)668-3813		(800)668-3813		(866)624-0168		(866)624-0168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	030	0	1	04	01	H7849_030_0	4	1					1	08/02/2022	2023.01	08/02/2022 10:41:57 PM Central Daylight Time	08/02/2022 01:43:14 PM Central Daylight Time	08/01/2022 11:42:53 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	030	0	2023	Central New Jersey		2		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			
H7849	031	0	1	04	01	H7849_031_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:40:47 PM Central Daylight Time	08/02/2022 01:44:40 PM Central Daylight Time	08/01/2022 11:43:24 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	031	0	2023	Central Pennsylvania		2		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			
H7849	032	0	1	04	01	H7849_032_0	4	1					1	06/01/2022	2023.01	06/01/2022 07:01:37 PM Central Daylight Time	08/02/2022 01:46:48 PM Central Daylight Time	08/01/2022 11:43:56 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Central Pennsylvania		2		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			
H7849	033	0	1	04	01	H7849_033_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:41:46 PM Central Daylight Time	08/02/2022 01:47:32 PM Central Daylight Time	08/01/2022 11:44:27 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	033	0	2023	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					1	08/02/2022	2023.01	08/02/2022 08:33:44 PM Central Daylight Time	08/02/2022 05:37:13 PM Central Daylight Time	08/01/2022 11:44:59 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	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	5	1					1	08/02/2022	2023.01	08/02/2022 08:34:54 PM Central Daylight Time	08/02/2022 01:04:01 PM Central Daylight Time	08/01/2022 11:45:30 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	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					1	08/02/2022	2023.01	08/02/2022 08:36:50 PM Central Daylight Time	08/02/2022 01:05:03 PM Central Daylight Time	08/01/2022 11:46:01 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Middle Tennessee/Chattanooga		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					1	08/02/2022	2023.01	08/02/2022 08:38:15 PM Central Daylight Time	08/02/2022 01:05:58 PM Central Daylight Time	08/01/2022 11:46:32 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	West Tennessee/Memphis		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	08/03/2022	2023.01	08/03/2022 09:28:55 AM Central Daylight Time	08/03/2022 09:05:38 AM Central Daylight Time	08/01/2022 11:47:04 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Houston/San Antonio		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	039	0	1	04	01	H7849_039_0	4	1					1	08/03/2022	2023.01	08/03/2022 09:30:10 AM Central Daylight Time	08/03/2022 09:06:19 AM Central Daylight Time	08/01/2022 11:47:35 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Valley		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	040	0	1	04	01	H7849_040_0	4	1					1	08/02/2022	2023.01	08/02/2022 09:03:27 PM Central Daylight Time	08/03/2022 09:07:08 AM Central Daylight Time	08/01/2022 11:48:06 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	East Texas/Dallas		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	041	0	1	04	01	H7849_041_0	4	1					1	08/04/2022	2023.01	08/04/2022 12:49:47 PM Central Daylight Time	08/03/2022 09:08:16 AM Central Daylight Time	08/01/2022 11:48:37 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	El Paso		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	042	0	1	04	01	H7849_042_0	4	1					1	08/02/2022	2023.01	08/02/2022 09:05:26 PM Central Daylight Time	08/03/2022 09:09:00 AM Central Daylight Time	08/01/2022 11:49:08 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Oklahoma City		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)945-0564		(855)945-0564		(800)668-3813		(800)668-3813		(855)945-0564		(855)945-0564		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	043	0	1	04	01	H7849_043_0	4	1					1	08/02/2022	2023.01	08/02/2022 08:39:04 PM Central Daylight Time	08/02/2022 11:17:01 PM Central Daylight Time	08/01/2022 11:49:39 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Knoxville/Chattanooga		2		2			2									www.cignamedicare.com	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					1	08/03/2022	2023.01	08/03/2022 09:22:12 AM Central Daylight Time	08/02/2022 04:35:01 PM Central Daylight Time	08/01/2022 11:50:11 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	North Florida		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	045	0	1	04	01	H7849_045_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:25:25 PM Central Daylight Time	08/02/2022 12:23:02 PM Central Daylight Time	08/01/2022 11:50:42 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Charleston		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	046	0	1	04	01	H7849_046_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:26:41 PM Central Daylight Time	08/02/2022 12:23:37 PM Central Daylight Time	08/01/2022 11:51:13 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Triangle		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	047	0	1	04	01	H7849_047_0	5	1					1	08/02/2022	2023.01	08/02/2022 05:11:02 PM Central Daylight Time	08/02/2022 02:56:10 PM Central Daylight Time	08/01/2022 11:51:44 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Daytona/Jacksonville		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	048	0	1	04	01	H7849_048_0	5	1					1	08/02/2022	2023.01	08/02/2022 05:12:25 PM Central Daylight Time	08/02/2022 03:01:18 PM Central Daylight Time	08/01/2022 11:52:15 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Tampa		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	050	0	1	04	01	H7849_050_0	5	1					1	08/02/2022	2023.01	08/02/2022 07:06:33 PM Central Daylight Time	08/02/2022 11:34:33 AM Central Daylight Time	08/01/2022 11:52:47 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	050	0	2023	Colorado SW Corner		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	051	0	1	04	01	H7849_051_0	5	1					1	08/02/2022	2023.01	08/02/2022 07:07:11 PM Central Daylight Time	08/02/2022 11:37:14 AM Central Daylight Time	08/01/2022 11:53:18 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	051	0	2023	Colorado Western Slope		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	052	0	1	04	01	H7849_052_0	5	1					1	08/02/2022	2023.01	08/02/2022 07:33:11 PM Central Daylight Time	08/02/2022 04:12:32 PM Central Daylight Time	08/01/2022 11:53:49 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Connecticut		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(877)646-7738		(877)646-7738		(800)668-3813		(800)668-3813		(877)646-7738		(877)646-7738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	054	0	1	04	01	H7849_054_0	4	1					1	06/01/2022	2023.01	06/01/2022 06:58:21 PM Central Daylight Time	08/02/2022 04:13:10 PM Central Daylight Time	08/01/2022 11:54:20 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Connecticut		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(877)646-7738		(877)646-7738		(800)668-3813		(800)668-3813		(877)646-7738		(877)646-7738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	055	0	1	04	01	H7849_055_0	5	1					1	08/02/2022	2023.01	08/02/2022 07:32:40 PM Central Daylight Time	08/01/2022 05:36:30 PM Central Daylight Time	08/01/2022 11:54:51 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	055	0	2023	Portland		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(877)602-6226		(877)602-6226		(800)668-3813		(800)668-3813		(877)602-6226		(877)602-6226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	056	0	1	04	01	H7849_056_0	5	1					1	08/04/2022	2023.01	08/04/2022 12:50:23 PM Central Daylight Time	08/03/2022 09:40:18 AM Central Daylight Time	08/01/2022 11:55:22 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Southwest Florida		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(800)668-3813		(800)668-3813		(866)623-8056		(866)623-8056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	057	0	1	04	01	H7849_057_0	6	1					1	08/02/2022	2023.01	08/02/2022 05:48:59 PM Central Daylight Time	08/03/2022 05:11:22 PM Central Daylight Time	08/01/2022 11:55:54 AM Central Daylight Time			08/05/2022 08:36:58 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	057	0	2023	St. Louis		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	058	0	1	04	01	H7849_058_0	5	1					1	08/02/2022	2023.01	08/02/2022 05:50:18 PM Central Daylight Time	08/03/2022 05:12:27 PM Central Daylight Time	08/01/2022 11:56:25 AM Central Daylight Time			08/05/2022 08:36:58 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	058	0	2023	Southern Illinois		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	059	0	1	04	01	H7849_059_0	5	1					1	08/02/2022	2023.01	08/02/2022 05:51:25 PM Central Daylight Time	08/03/2022 05:18:48 PM Central Daylight Time	08/01/2022 11:56:56 AM Central Daylight Time			08/05/2022 08:36:58 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	059	0	2023	Southern Illinois		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(800)668-3813		(800)668-3813		(877)646-7743		(877)646-7743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	060	0	1	04	01	H7849_060_0	4	1					1	08/02/2022	2023.01	08/02/2022 08:44:51 PM Central Daylight Time	08/02/2022 01:07:39 PM Central Daylight Time	08/01/2022 11:57:27 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	North Mississippi		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	062	0	1	04	01	H7849_062_0	5	1					1	05/24/2022	2023.01	05/24/2022 10:18:00 PM Central Daylight Time	08/03/2022 09:09:36 AM Central Daylight Time	08/01/2022 11:57:58 AM Central Daylight Time			08/04/2022 02:40:10 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	2023	Houston/San Antonio		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(800)668-3813		(800)668-3813		(855)982-6150		(855)982-6150		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	064	1	1	04	01	H7849_064_1	5	1					1	08/02/2022	2023.01	08/02/2022 04:33:47 PM Central Daylight Time	08/02/2022 04:36:06 PM Central Daylight Time	08/01/2022 11:58:29 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Access Medicare (PPO)	01	04		1			H7849	064	1	2023	Alabama/North Florida/South Mississippi	Central and South AL/North FL/South MS	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	064	2	1	04	01	H7849_064_2	4	1					1	08/02/2022	2023.01	08/02/2022 04:34:55 PM Central Daylight Time	08/02/2022 04:36:58 PM Central Daylight Time	08/01/2022 11:59:00 AM Central Daylight Time			08/04/2022 02:40:10 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Access Medicare (PPO)	01	04		1			H7849	064	2	2023	Alabama/North Florida/South Mississippi	North Alabama	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	065	0	1	04	01	H7849_065_0	5	1					1	08/02/2022	2023.01	08/02/2022 04:42:06 PM Central Daylight Time	08/01/2022 04:55:17 PM Central Daylight Time	08/01/2022 11:59:32 AM Central Daylight Time			08/04/2022 01:36:02 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	065	0	2023	Central Arizona		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	066	0	1	04	01	H7849_066_0	6	1					1	08/02/2022	2023.01	08/02/2022 04:42:58 PM Central Daylight Time	08/01/2022 04:55:52 PM Central Daylight Time	08/01/2022 12:00:04 PM Central Daylight Time			08/04/2022 01:36:02 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	066	0	2023	Central Arizona		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	067	0	1	04	01	H7849_067_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:43:19 PM Central Daylight Time	08/02/2022 04:05:56 PM Central Daylight Time	08/01/2022 12:00:35 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	067	0	2023	Savannah		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	068	0	1	04	01	H7849_068_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:44:48 PM Central Daylight Time	08/02/2022 04:06:56 PM Central Daylight Time	08/01/2022 12:01:07 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	068	0	2023	Columbus		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	069	0	1	04	01	H7849_069_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:45:37 PM Central Daylight Time	08/02/2022 04:07:48 PM Central Daylight Time	08/01/2022 12:01:38 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	069	0	2023	Metro Georgia/Columbus		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	070	0	1	04	01	H7849_070_0	4	1					1	08/02/2022	2023.01	08/02/2022 05:57:32 PM Central Daylight Time	08/02/2022 04:16:01 PM Central Daylight Time	08/01/2022 12:02:10 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	070	0	2023	Richmond		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	071	0	1	04	01	H7849_071_0	4	1					1	06/01/2022	2023.01	06/01/2022 06:53:11 PM Central Daylight Time	08/02/2022 04:17:52 PM Central Daylight Time	08/01/2022 12:02:42 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	071	0	2023	Richmond		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	072	0	1	04	01	H7849_072_0	2	1				0	0	06/01/2022	2023.01	06/01/2022 06:52:53 PM Central Daylight Time	05/30/2022 08:04:45 PM Central Daylight Time				06/02/2022 11:22:19 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Courage Medicare (PPO)	01	04		1			H7849	072	0	2023	Kansas City		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7849	073	0	1	04	01	H7849_073_0	2	1				0	0	06/01/2022	2023.01	06/01/2022 06:52:38 PM Central Daylight Time	05/30/2022 08:05:30 PM Central Daylight Time				06/02/2022 11:22:19 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Courage Medicare (PPO)	01	04		1			H7849	073	0	2023	Southern Illinois		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7849	074	0	1	04	01	H7849_074_0	2	1				0	0	06/01/2022	2023.01	06/01/2022 06:52:18 PM Central Daylight Time	05/30/2022 08:06:06 PM Central Daylight Time				06/02/2022 11:22:19 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Courage Medicare (PPO)	01	04		1			H7849	074	0	2023	St. Louis		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7849	076	0	1	04	01	H7849_076_0	5	1						08/02/2022	2023.01	08/02/2022 05:52:27 PM Central Daylight Time	08/03/2022 05:20:19 PM Central Daylight Time	08/01/2022 12:03:13 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	076	0	2023	Southern Illinois		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	077	0	1	04	01	H7849_077_0	5	1						08/02/2022	2023.01	08/02/2022 05:53:18 PM Central Daylight Time	08/03/2022 05:21:34 PM Central Daylight Time	08/01/2022 12:03:45 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	077	0	2023	St. Louis		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	078	0	1	04	01	H7849_078_0	2	1				0	0	06/01/2022	2023.01	06/01/2022 06:51:32 PM Central Daylight Time	05/30/2022 07:42:19 PM Central Daylight Time				06/02/2022 11:22:19 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Courage Medicare (PPO)	01	04		1			H7849	078	0	2023	Chicago		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7849	079	0	1	04	01	H7849_079_0	4	1						06/01/2022	2023.01	06/01/2022 06:51:18 PM Central Daylight Time	08/02/2022 06:39:10 PM Central Daylight Time	08/01/2022 12:04:17 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	079	0	2023	Chicago		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	080	0	1	04	01	H7849_080_0	5	1						08/02/2022	2023.01	08/02/2022 06:06:26 PM Central Daylight Time	08/03/2022 05:05:07 PM Central Daylight Time	08/01/2022 12:04:49 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	080	0	2023	Chicago		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	081	0	1	04	01	H7849_081_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:13:30 PM Central Daylight Time	08/02/2022 04:19:07 PM Central Daylight Time	08/01/2022 12:05:20 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	081	0	2023	Connecticut		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	082	0	1	04	01	H7849_082_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:14:34 PM Central Daylight Time	08/02/2022 01:48:15 PM Central Daylight Time	08/01/2022 12:05:51 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	082	0	2023	New York City		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	083	0	1	04	01	H7849_083_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:15:58 PM Central Daylight Time	08/02/2022 01:48:57 PM Central Daylight Time	08/01/2022 12:06:23 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	083	0	2023	Westchester		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	084	0	1	04	01	H7849_084_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:16:54 PM Central Daylight Time	08/02/2022 01:49:53 PM Central Daylight Time	08/01/2022 12:06:54 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	084	0	2023	Long Island		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	085	0	1	04	01	H7849_085_0	4	1					1	06/01/2022	2023.01	06/01/2022 06:49:50 PM Central Daylight Time	08/02/2022 01:50:38 PM Central Daylight Time	08/01/2022 12:07:25 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	085	0	2023	Long Island		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	086	0	1	04	01	H7849_086_0	3	1				0	0	07/18/2022	2023.01	07/18/2022 02:37:29 PM Central Daylight Time	05/30/2022 01:52:21 PM Central Daylight Time				07/18/2022 04:55:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Courage Medicare (PPO)	01	04		1			H7849	086	0	2023	Long Island/Queens/ Westchester		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7849	087	0	1	04	01	H7849_087_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:27:42 PM Central Daylight Time	08/02/2022 01:51:19 PM Central Daylight Time	08/01/2022 12:07:56 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	087	0	2023	Long Island		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	088	0	1	04	01	H7849_088_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:31:28 PM Central Daylight Time	08/03/2022 05:06:05 PM Central Daylight Time	08/01/2022 12:08:28 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	088	0	2023	Greater Dayton		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	089	0	1	04	01	H7849_089_0	3	1				0	0	07/18/2022	2023.01	07/18/2022 02:38:04 PM Central Daylight Time	05/30/2022 07:52:05 PM Central Daylight Time				07/18/2022 04:55:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Courage Medicare (PPO)	01	04		1			H7849	089	0	2023	Greater Dayton		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7849	090	0	1	04	01	H7849_090_0	3	1				0	0	07/18/2022	2023.01	07/18/2022 02:38:17 PM Central Daylight Time	05/30/2022 07:53:51 PM Central Daylight Time				07/18/2022 04:55:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Courage Medicare (PPO)	01	04		1			H7849	090	0	2023	Cleveland		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7849	101	0	1	04	01	H7849_101_0	4	1					1	08/02/2022	2023.01	08/02/2022 08:16:20 PM Central Daylight Time	08/03/2022 09:41:44 AM Central Daylight Time	08/01/2022 12:08:59 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	101	0	2023	Southeast Florida		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	102	1	1	04	01	H7849_102_1	4	1					1	08/02/2022	2023.01	08/02/2022 08:44:28 PM Central Daylight Time	08/02/2022 01:08:37 PM Central Daylight Time	08/01/2022 12:09:30 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	102	1	2023	Arkansas	Jonesboro	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	102	2	1	04	01	H7849_102_2	4	1					1	08/02/2022	2023.01	08/02/2022 08:46:10 PM Central Daylight Time	08/02/2022 01:10:21 PM Central Daylight Time	08/01/2022 12:10:02 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	102	2	2023	Arkansas	Central Arkansas	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	102	3	1	04	01	H7849_102_3	4	1					1	08/02/2022	2023.01	08/02/2022 08:47:18 PM Central Daylight Time	08/02/2022 01:11:06 PM Central Daylight Time	08/01/2022 12:10:33 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	102	3	2023	Arkansas	West Arkansas	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	102	4	1	04	01	H7849_102_4	4	1					1	08/02/2022	2023.01	08/02/2022 08:48:35 PM Central Daylight Time	08/02/2022 01:11:50 PM Central Daylight Time	08/01/2022 12:11:04 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	102	4	2023	Arkansas	Northwest Arkansas	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	103	0	1	04	01	H7849_103_0	4	1					1	08/03/2022	2023.01	08/03/2022 09:31:09 AM Central Daylight Time	08/03/2022 09:10:11 AM Central Daylight Time	08/01/2022 12:11:36 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	103	0	2023	Corpus Christi		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	104	0	1	04	01	H7849_104_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:42:52 PM Central Daylight Time	08/02/2022 01:52:06 PM Central Daylight Time	08/01/2022 12:12:07 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	104	0	2023	Central Pennsylvania		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	105	0	1	04	01	H7849_105_0	4	1					1	06/01/2022	2023.01	06/01/2022 06:46:30 PM Central Daylight Time	08/02/2022 01:52:55 PM Central Daylight Time	08/01/2022 12:12:38 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	105	0	2023	Central Pennsylvania		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	106	0	1	04	01	H7849_106_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:43:41 PM Central Daylight Time	08/02/2022 01:53:41 PM Central Daylight Time	08/01/2022 12:13:10 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	106	0	2023	Western Pennsylvania		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	107	0	1	04	01	H7849_107_0	4	1					1	06/01/2022	2023.01	06/01/2022 06:46:08 PM Central Daylight Time	08/02/2022 01:54:22 PM Central Daylight Time	08/01/2022 12:13:42 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	107	0	2023	Western Pennsylvania		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	108	0	1	04	01	H7849_108_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:46:07 PM Central Daylight Time	08/02/2022 01:55:02 PM Central Daylight Time	08/01/2022 12:14:13 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	108	0	2023	Northwest Pennsylvania		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	109	0	1	04	01	H7849_109_0	4	1					1	06/01/2022	2023.01	06/01/2022 06:45:57 PM Central Daylight Time	08/02/2022 01:55:43 PM Central Daylight Time	08/01/2022 12:14:44 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	109	0	2023	Northwest Pennsylvania		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	110	0	1	04	01	H7849_110_0	4	1					1	08/02/2022	2023.01	08/02/2022 07:57:19 PM Central Daylight Time	08/02/2022 01:56:28 PM Central Daylight Time	08/01/2022 12:15:16 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	110	0	2023	Southern New Jersey		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	111	0	1	04	01	H7849_111_0	4	1					1	08/02/2022	2023.01	08/02/2022 10:43:15 PM Central Daylight Time	08/02/2022 01:57:16 PM Central Daylight Time	08/01/2022 12:15:47 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Savings Medicare (PPO)	01	04		1			H7849	111	0	2023	Western Pennsylvania		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(800)668-3813		(800)668-3813		(855)454-9039		(855)454-9039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	801	0	1	04	01	H7849_801_0	3	1						06/15/2022	2023.01	06/15/2022 04:10:02 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	801	0	2023	Statewide TN		1	40560	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	05/22/2022	2023.01	05/22/2022 07:13:05 PM Central Daylight Time					06/02/2022 11:22:19 AM 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	2023	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	3	1						06/15/2022	2023.01	06/15/2022 04:10:18 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	803	0	2023	Statewide DC, DE, MD, VA		1	71760	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	3	1				0	0	06/15/2022	2023.01	06/15/2022 04:10:34 PM Central Daylight Time					06/16/2022 10:27:43 AM 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	2023	Statewide DC, DE, MD, VA		1	9756	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	3	1						06/15/2022	2023.01	06/15/2022 04:10:48 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	805	0	2023	Statewide NJ & PA		1	2244	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	3	1				0	0	06/15/2022	2023.01	06/15/2022 04:11:05 PM Central Daylight Time					06/16/2022 10:27:43 AM 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	2023	Statewide NJ & PA		1	5148	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	3	1						06/15/2022	2023.01	06/15/2022 04:11:21 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	807	0	2023	Statewide NC		1	6204	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	05/22/2022	2023.01	05/22/2022 07:11:23 PM Central Daylight Time					06/02/2022 11:22:19 AM 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	2023	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	817	0	1	04	01	H7849_817_0	3	1						06/15/2022	2023.01	06/15/2022 04:11:35 PM Central Daylight Time					06/16/2022 10:27:43 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	817	0	2023	Nationwide		1	10332	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	05/22/2022	2023.01	05/22/2022 06:57:22 PM Central Daylight Time					06/02/2022 11:22:19 AM 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	2023	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									
H7855	001	0	1	20	08	H7855_001_0	1	1						05/27/2022	2023.01	05/27/2022 06:26:50 AM Pacific Daylight Time		05/26/2022 04:46:58 PM Pacific Daylight Time			05/27/2022 06:31:00 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	2023	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						05/27/2022	2023.01	05/27/2022 06:27:04 AM Pacific Daylight Time		05/26/2022 04:47:19 PM Pacific Daylight Time			05/27/2022 06:31:00 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	2023	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																
H7917	009	0	1	04	01	H7917_009_0	3	1					1	08/05/2022	2023.01	08/05/2022 11:52:20 AM Eastern Daylight Time	08/03/2022 05:29:56 PM Eastern Daylight Time	08/01/2022 04:21:50 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	009	0	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:52:45 AM Eastern Daylight Time	08/03/2022 05:46:02 PM Eastern Daylight Time	08/01/2022 04:29:36 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	010	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:53:11 AM Eastern Daylight Time	08/03/2022 05:58:44 PM Eastern Daylight Time	08/01/2022 04:37:20 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	011	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:48:38 AM Eastern Daylight Time	08/03/2022 06:13:12 PM Eastern Daylight Time	08/01/2022 04:45:04 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	012	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:50:04 AM Eastern Daylight Time	08/03/2022 06:28:08 PM Eastern Daylight Time	08/01/2022 04:52:48 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	013	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:50:31 AM Eastern Daylight Time	08/03/2022 06:43:54 PM Eastern Daylight Time	08/01/2022 05:00:32 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	014	0	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:51:00 AM Eastern Daylight Time	08/03/2022 06:56:14 PM Eastern Daylight Time	08/01/2022 05:08:18 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	015	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:46:40 AM Eastern Daylight Time	08/03/2022 07:10:40 PM Eastern Daylight Time	08/01/2022 05:16:12 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	030	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:47:03 AM Eastern Daylight Time	08/03/2022 07:23:22 PM Eastern Daylight Time	08/01/2022 05:23:56 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	031	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:53:58 AM Eastern Daylight Time	08/03/2022 07:37:34 PM Eastern Daylight Time	08/01/2022 05:31:40 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	032	0	2023	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	4	1					1	08/05/2022	2023.01	08/05/2022 11:54:39 AM Eastern Daylight Time	08/03/2022 07:51:24 PM Eastern Daylight Time	08/01/2022 05:39:24 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	033	0	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:44:42 AM Eastern Daylight Time	08/03/2022 08:05:16 PM Eastern Daylight Time	08/01/2022 05:47:14 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	01	04		1			H7917	034	0	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:45:04 AM Eastern Daylight Time	08/03/2022 08:19:28 PM Eastern Daylight Time	08/01/2022 05:55:04 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	01	04		1			H7917	035	0	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:45:26 AM Eastern Daylight Time	08/03/2022 08:35:16 PM Eastern Daylight Time	08/01/2022 06:02:54 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	01	04		1			H7917	036	0	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:45:52 AM Eastern Daylight Time	08/03/2022 08:47:40 PM Eastern Daylight Time	08/01/2022 06:10:56 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	01	04		1			H7917	037	0	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:47:31 AM Eastern Daylight Time	08/03/2022 09:00:54 PM Eastern Daylight Time	08/01/2022 06:18:40 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	038	0	2023	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	3	1				0	0	08/05/2022	2023.01	08/05/2022 10:55:56 AM Eastern Daylight Time	06/04/2022 09:14:26 AM Eastern Daylight Time				08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Freedom (PPO)	01	04		1			H7917	039	0	2023	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	040	0	1	04	01	H7917_040_0	4	1					1	08/05/2022	2023.01	08/05/2022 11:47:54 AM Eastern Daylight Time	08/03/2022 09:34:10 PM Eastern Daylight Time	08/01/2022 06:26:24 PM Eastern Daylight Time			08/05/2022 12:55:13 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	040	0	2023	North Georgia		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	801	0	1	04	01	H7917_801_0	1	1						05/13/2022	2023.01	05/13/2022 03:57:02 PM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	801	0	2023	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	1	1						05/20/2022	2023.01	05/20/2022 01:40:09 PM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	802	0	2023	22 County Region		1	100	2			2									bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	803	0	1	04	01	H7917_803_0	1	1				0	0	05/16/2022	2023.01	05/16/2022 07:56:50 AM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	803	0	2023	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	5	1						08/01/2022	2023.01	08/01/2022 01:07:21 PM Central Daylight Time	08/03/2022 09:06:11 PM Eastern Daylight Time	07/30/2022 10:32:18 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY INDIANA, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent Reward (HMO)	01	01		1			H7925	001	0	2023	Central, Southeast and Southwest Indiana Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7925	002	0	1	01	01	H7925_002_0	5	1						08/01/2022	2023.01	08/01/2022 01:08:14 PM Central Daylight Time	08/03/2022 09:07:26 PM Eastern Daylight Time	07/30/2022 10:32:50 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY INDIANA, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent Secure (HMO)	01	01		1			H7925	002	0	2023	Central, Southeast and Southwest Indiana Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7925	003	0	1	01	01	H7925_003_0	6	1	2	1			0	07/15/2022	2023.01	07/15/2022 08:45:11 AM Central Daylight Time	08/03/2022 09:08:41 PM Eastern Daylight Time	07/30/2022 10:33:22 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY INDIANA, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent DSNP (HMO D-SNP)	01	01		1			H7925	003	0	2023	Central, Southeast and Southwest Indiana		2		2			1	3		1					1	www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(833)525-0824		(833)525-0824		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7993	001	0	1	01	01	H7993_001_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 03:30:53 PM US Eastern Daylight Time	08/04/2022 09:49:21 AM Eastern Daylight Time	07/31/2022 02:01:23 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted CORE Greater Houston (HMO)	01	01		1			H7993	001	0	2023	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	12	1			2		1	09/10/2022	2023.01	09/10/2022 12:53:23 AM US Eastern Daylight Time	08/04/2022 09:49:55 AM Eastern Daylight Time	07/31/2022 02:01:44 PM Eastern Daylight Time			09/27/2022 10:27:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted PRIME Greater Houston (HMO)	01	01		1			H7993	002	0	2023	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	10	1			2		0	08/03/2022	2023.01	08/03/2022 03:31:44 PM US Eastern Daylight Time	08/04/2022 09:50:25 AM Eastern Daylight Time	07/31/2022 02:02:06 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted CORE San Antonio (HMO)	01	01		1			H7993	003	0	2023	Greater San Antonio		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			2		0	07/21/2022	2023.01	07/21/2022 12:35:53 PM US Eastern Daylight Time	08/04/2022 09:50:52 AM Eastern Daylight Time	07/31/2022 02:02:27 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted PRIME San Antonio (HMO)	01	01		1			H7993	004	0	2023	Greater San Antonio		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	9	1		1	2		1	08/03/2022	2023.01	08/03/2022 03:32:00 PM US Eastern Daylight Time	08/04/2022 09:51:24 AM Eastern Daylight Time	07/31/2022 02:02:49 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted BEWELL San Antonio - D (HMO C-SNP)	01	01		1			H7993	005	0	2023	Greater San Antonio		2		2			1	4			00000010000000000000000					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	006	0	1	01	01	H7993_006_0	11	1			2		0	08/03/2022	2023.01	08/03/2022 03:32:22 PM US Eastern Daylight Time	08/04/2022 09:51:56 AM Eastern Daylight Time	07/31/2022 02:03:10 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted GIVEBACK Greater Houston (HMO)	01	01		1			H7993	006	0	2023	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	007	0	1	01	01	H7993_007_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 03:33:24 PM US Eastern Daylight Time	08/04/2022 09:58:51 AM Eastern Daylight Time	07/31/2022 02:03:32 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted CORE El Paso (HMO)	01	01		1			H7993	007	0	2023	El Paso and Hudspeth 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			
H7993	008	0	1	01	01	H7993_008_0	11	1			2		0	08/03/2022	2023.01	08/03/2022 03:33:46 PM US Eastern Daylight Time	08/04/2022 09:59:18 AM Eastern Daylight Time	07/31/2022 02:03:53 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted GIVEBACK El Paso (HMO)	01	01		1			H7993	008	0	2023	El Paso and Hudspeth 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			
H7993	009	0	1	01	01	H7993_009_0	9	1		1	1		0	07/21/2022	2023.01	07/21/2022 12:59:22 PM US Eastern Daylight Time	08/04/2022 09:59:41 AM Eastern Daylight Time	07/31/2022 02:04:15 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted BEWELL El Paso - D (HMO C-SNP)	01	01		1			H7993	009	0	2023	El Paso and Hudspeth Counties		2		2			1	4			00000010000000000000000					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	7	1					1	08/05/2022	2023.01	08/05/2022 11:43:54 AM Eastern Daylight Time	08/05/2022 10:47:00 AM Eastern Daylight Time	08/03/2022 01:41:24 PM Eastern Daylight Time			08/05/2022 12:31:55 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross Total (PPO)	01	04		1			H8003	001	0	2023	Upstate		2		2			2									www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(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	7	1					1	08/05/2022	2023.01	08/05/2022 11:43:30 AM Eastern Daylight Time	08/05/2022 10:47:49 AM Eastern Daylight Time	08/03/2022 01:42:04 PM Eastern Daylight Time			08/05/2022 12:31:55 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross Total (PPO)	01	04		1			H8003	002	0	2023	Midlands/Coastal		2		2			2									www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(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	7	1					1	08/05/2022	2023.01	08/05/2022 11:43:06 AM Eastern Daylight Time	08/05/2022 10:40:52 AM Eastern Daylight Time	08/03/2022 01:42:41 PM Eastern Daylight Time			08/05/2022 12:31:55 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross Total (PPO)	01	04		1			H8003	003	0	2023	Lowcountry		2		2			2									www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(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	7	1					1	08/05/2022	2023.01	08/05/2022 11:44:44 AM Eastern Daylight Time	08/05/2022 10:48:30 AM Eastern Daylight Time	08/03/2022 01:43:18 PM Eastern Daylight Time			08/05/2022 12:28:05 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross Total Value (PPO)	01	04		1			H8003	004	0	2023	Upstate		2		2			2									www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(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	8	1					1	08/05/2022	2023.01	08/05/2022 11:44:27 AM Eastern Daylight Time	08/05/2022 10:49:08 AM Eastern Daylight Time	08/03/2022 01:43:54 PM Eastern Daylight Time			08/05/2022 12:28:05 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross Total Value (PPO)	01	04		1			H8003	005	0	2023	Midlands/Coastal		2		2			2									www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(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	7	1					1	08/05/2022	2023.01	08/05/2022 11:46:08 AM Eastern Daylight Time	08/05/2022 10:49:52 AM Eastern Daylight Time	08/03/2022 01:44:25 PM Eastern Daylight Time			08/05/2022 12:28:05 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross Total Value (PPO)	01	04		1			H8003	006	0	2023	Lowcountry		2		2			2									www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(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	6	1				0	0	07/07/2022	2023.01	07/07/2022 04:05:56 PM Eastern Daylight Time	07/20/2022 03:22:45 PM Eastern Daylight Time				07/21/2022 04:02:21 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross Blue Basic (PPO)	01	04		1			H8003	007	0	2023	South Carolina		2		2			2									www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(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	1	1						06/02/2022	2023.01	06/02/2022 09:58:23 AM Eastern Daylight Time					06/02/2022 10:21:53 AM 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	2023	Nationwide		1	0	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	1	1						05/20/2022	2023.01	05/20/2022 05:18:08 PM Eastern Daylight Time					06/02/2022 10:21:53 AM 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	2023	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	1	1a;1b;2;7k;9a1;9b;11a;11b;15;	2		1									
H8003	803	0	1	04	01	H8003_803_0	1	1				0	0	06/02/2022	2023.01	06/02/2022 09:59:04 AM Eastern Daylight Time					06/02/2022 10:21:53 AM 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	2023	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	1	1a;1b;2;7k;8a;8b1;8b2;9a1;9b;9d;11a;11b;15;	2		1									
H8003	804	0	1	04	01	H8003_804_0	1	1				0	0	05/20/2022	2023.01	05/20/2022 05:35:53 PM Eastern Daylight Time					06/02/2022 10:21:53 AM 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	2023	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	1	1a;1b;2;7k;8a;8b1;8b2;9a1;9b;9d;11a;11b;15;	2		1									
H8010	002	0	1	01	01	H8010_002_0	8	1					1	08/05/2022	2023.01	08/05/2022 06:15:10 PM Eastern Daylight Time	08/05/2022 08:15:38 PM Eastern Daylight Time	08/05/2022 08:14:13 PM Eastern Daylight Time			08/05/2022 08:54:12 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	2023	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	5	1						08/04/2022	2023.01	08/04/2022 07:48:36 PM Eastern Daylight Time	08/05/2022 05:36:48 PM Eastern Daylight Time	08/11/2022 05:03:52 PM Eastern Daylight Time			08/11/2022 06:16:29 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	2023	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			
H8014	001	0	1	04	01	H8014_001_0	7	1					1	08/03/2022	2023.01	08/03/2022 08:00:01 AM Central Daylight Time	08/04/2022 03:21:26 PM Central Daylight Time	08/04/2022 03:32:26 PM Central Daylight Time			08/04/2022 06:18:56 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (PPO)	01	04		1			H8014	001	0	2023	Metro Denver, Boulder, Fort 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			
H8014	002	0	1	04	01	H8014_002_0	6	1					1	08/03/2022	2023.01	08/03/2022 08:00:53 AM Central Daylight Time	08/04/2022 03:22:21 PM Central Daylight Time	08/04/2022 03:33:12 PM Central Daylight Time			08/04/2022 06:18:56 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (PPO)	01	04		1			H8014	002	0	2023	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			
H8019	002	0	1	02	01	H8019_002_0	6	1					1	08/05/2022	2023.01	08/05/2022 02:25:09 PM Central Daylight Time	08/05/2022 11:11:49 AM Central Daylight Time	08/04/2022 01:12:17 PM Central Daylight Time			08/05/2022 02:55:41 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirsthealth.com/medicareadvantage	SSM Health Plan Integrity (HMO-POS)	01	02		1			H8019	002	0	2023	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	5	1				0	0	07/18/2022	2023.01	07/18/2022 02:21:05 PM Central Daylight Time	06/04/2022 11:26:04 PM Central Daylight Time				07/18/2022 03:20:59 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirsthealth.com/medicareadvantage	SSM Health Plan Harmony (HMO-POS)	01	02		1			H8019	003	0	2023	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	005	0	1	02	01	H8019_005_0	6	1					1	08/05/2022	2023.01	08/05/2022 12:17:23 PM Central Daylight Time	08/05/2022 11:09:08 AM Central Daylight Time	08/04/2022 01:12:44 PM Central Daylight Time			08/05/2022 02:55:41 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirsthealth.com/medicareadvantage	SSM Health Plan FlexSpend (HMO-POS)	01	02		1			H8019	005	0	2023	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	801	0	1	01	01	H8019_801_0	3	1						05/02/2022	2023.01	05/02/2022 01:55:42 PM Central Daylight Time					06/05/2022 08:00:26 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MAPD CY (HMO)	01	01		1			H8019	801	0	2023	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						05/02/2022	2023.01	05/02/2022 01:55:23 PM Central Daylight Time					06/05/2022 08:00:26 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MAPD Non CY (HMO)	01	01		1			H8019	802	0	2023	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	05/02/2022	2023.01	05/02/2022 01:54:51 PM Central Daylight Time					06/05/2022 08:00:26 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MA Only (HMO)	01	01		1			H8019	803	0	2023	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						05/02/2022	2023.01	05/02/2022 01:54:30 PM Central Daylight Time					06/05/2022 08:00:26 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MAPD CY (HMO-POS)	01	02		1			H8019	804	0	2023	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						05/02/2022	2023.01	05/02/2022 01:54:03 PM Central Daylight Time					06/05/2022 08:00:26 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MAPD Non CY (HMO-POS)	01	02		1			H8019	805	0	2023	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	05/02/2022	2023.01	05/02/2022 01:53:36 PM Central Daylight Time					06/05/2022 08:00:26 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MA Only (HMO-POS)	01	02		1			H8019	806	0	2023	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	9	1						05/25/2023	2023.01	05/25/2023 01:47:36 PM Central Daylight Time					05/25/2023 01:50:09 PM 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	2023	Wayne, Macomb and Southwest Michigan Regions		2	106000	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	1	1						06/02/2022	2023.01	06/02/2022 04:14:41 PM Pacific Daylight Time					06/05/2022 06:47:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF ILLINOIS, INC.	Molina Healthcare of Illinois	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8046	001	0	2023	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	08/04/2022	2023.01	08/04/2022 10:42:17 AM Central Daylight Time	08/05/2022 12:13:26 PM Central Daylight Time	08/04/2022 12:44:44 PM Central Daylight Time			08/05/2022 12:33:06 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct PPO Plus (PPO)	01	04		1			H8064	002	0	2023	Sandhills		2		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	801	0	1	04	01	H8064_801_0	1	1				0	0	06/02/2022	2023.01	06/02/2022 11:15:14 AM Central Daylight Time					06/03/2022 11:30:44 AM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	Medicare Employer PPO (PPO)	01	04		1			H8064	801	0	2023	North Carolina		1	0	1	1		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)-										1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	1	2;	1									
H8064	802	0	1	04	01	H8064_802_0	1	1						06/02/2022	2023.01	06/02/2022 11:21:23 AM Central Daylight Time					06/03/2022 11:30:44 AM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	Medicare Employer PPO Rx (PPO)	01	04		1			H8064	802	0	2023	North Carolina		1	0	1	1		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)-		1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	1	2;	1									
H8064	803	0	1	04	01	H8064_803_0	1	1						06/02/2022	2023.01	06/02/2022 11:23:15 AM Central Daylight Time					06/03/2022 11:30:44 AM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	Medicare Employer PPO  Rx- non-calendar year (PPO)	01	04		1			H8064	803	0	2023	North Carolina		1	0	1	1		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)-		1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	1	2;	1									
H8067	001	0	1	01	01	H8067_001_0	12	1		1				08/04/2022	2023.01	08/04/2022 05:45:17 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time			08/04/2022 09:42:14 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	2023	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	10	1		1				08/04/2022	2023.01	08/04/2022 06:15:18 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time			08/04/2022 09:42:14 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	2023	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			
H8070	001	0	1	04	01	H8070_001_0	6	1						09/14/2022	2023.01	09/14/2022 01:32:56 PM Central Daylight Time	08/04/2022 03:24:18 PM Central Daylight Time	08/01/2022 10:59:24 AM Central Daylight Time			09/15/2022 02:07:40 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Your Choice (PPO)	01	04		1			H8070	001	0	2023	Twin Cities Metropolitan Area: 14 Counties		2		2			2									www.ucare.org	https://home.ucare.org	https://home.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			
H8070	002	0	1	04	01	H8070_002_0	3	1						09/14/2022	2023.01	09/14/2022 01:39:20 PM Central Daylight Time	08/04/2022 02:47:16 PM Central Daylight Time	08/01/2022 11:14:06 AM Central Daylight Time			09/15/2022 02:07:40 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Your Choice Plus (PPO)	01	04		1			H8070	002	0	2023	Twin Cities Metropolitan Area: 14 Counties		2		2			2									www.ucare.org	https://home.ucare.org	https://home.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			
H8082	001	0	1	20	08	H8082_001_0	1	1						05/31/2022	2023.01	05/31/2022 02:25:58 PM Mountain Daylight Time		05/26/2022 12:38:01 PM Mountain Daylight Time			05/31/2022 02:26:50 PM Mountain Daylight Time	STOCKTON PACE	WelbeHealth Sierra PACE	https://welbehealth.com/locations/	WelbeHealth Sierra PACE (PACE)	08	20		1			H8082	001	0	2023	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						05/31/2022	2023.01	05/31/2022 02:26:08 PM Mountain Daylight Time		05/26/2022 12:38:01 PM Mountain Daylight Time			05/31/2022 02:26:50 PM Mountain Daylight Time	STOCKTON PACE	WelbeHealth Sierra PACE	https://welbehealth.com/locations/	WelbeHealth Sierra PACE (PACE)	08	20		1			H8082	002	0	2023	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	4	1			2		1	05/31/2022	2023.01	05/31/2022 06:01:07 PM Eastern Daylight Time	08/03/2022 04:38:47 PM Eastern Daylight Time	07/30/2022 09:49:36 AM Eastern Daylight Time			08/04/2022 11:51:45 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H8087-001 (PPO)	01	04		1			H8087	001	0	2023	Select Counties in Michigan		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			2		1	07/13/2022	2023.01	07/13/2022 02:12:51 PM Eastern Daylight Time	08/03/2022 04:41:42 PM Eastern Daylight Time	07/30/2022 09:50:02 AM Eastern Daylight Time			08/04/2022 11:51:45 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H8087-002 (PPO)	01	04		1			H8087	002	0	2023	Select counties in Michigan		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 10:52:01 PM Eastern Daylight Time	08/03/2022 04:42:40 PM Eastern Daylight Time	07/30/2022 09:50:28 AM Eastern Daylight Time			08/04/2022 11:51:45 AM 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	2023	Select Counties in Michigan		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			2		1	08/01/2022	2023.01	08/01/2022 02:03:25 PM Eastern Daylight Time	08/03/2022 04:45:05 PM Eastern Daylight Time	07/30/2022 09:50:54 AM Eastern Daylight Time			08/04/2022 11:51:45 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H8087-004 (PPO)	01	04		1			H8087	004	0	2023	Michigan (Non-Detroit)		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1		1				08/02/2022	2023.01	08/02/2022 12:11:11 PM Central Daylight Time	08/01/2022 11:11:19 PM Central Daylight Time	07/29/2022 05:30:04 PM Central Daylight Time			08/03/2022 09:32:37 AM Central Daylight Time	GEORGIA ASSURANCE, INC.	Georgia Health Advantage	GeorgiaHealthAdvantage.com	Georgia Health Advantage (HMO I-SNP)	01	01		1			H8093	001	0	2023	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	1	01	7c;7i;	
H8093	002	0	1	01	01	H8093_002_0	4	1		1				08/02/2022	2023.01	08/02/2022 12:11:53 PM Central Daylight Time	08/01/2022 11:12:22 PM Central Daylight Time	07/29/2022 05:29:28 PM Central Daylight Time			08/03/2022 09:32:37 AM Central Daylight Time	GEORGIA ASSURANCE, INC.	Georgia Health Advantage	GeorgiaHealthAdvantage.com	Georgia Health Advantage Choice (HMO I-SNP)	01	01		1			H8093	002	0	2023	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	1	01	7c;7i;	
H8095	001	0	1	01	01	H8095_001_0	7	1					1	08/05/2022	2023.01	08/05/2022 06:17:17 PM Eastern Daylight Time	08/05/2022 06:05:10 PM Eastern Daylight Time	08/05/2022 06:42:50 PM Eastern Daylight Time			08/05/2022 06:49:14 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage HMO (HMO)	01	01		1			H8095	001	0	2023	Iowa		2		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	4	1						05/02/2022	2023.01	05/02/2022 11:53:48 AM Eastern Daylight Time					06/06/2022 07:13:11 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Group HMO (HMO)	01	01		1			H8095	801	0	2023	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	4	1				0	0	05/02/2022	2023.01	05/02/2022 11:54:09 AM Eastern Daylight Time					06/06/2022 07:13:11 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Group HMO (HMO)	01	01		1			H8095	802	0	2023	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	4	1						05/02/2022	2023.01	05/02/2022 11:53:27 AM Eastern Daylight Time					06/06/2022 07:13:11 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Group HMOPOS (HMO-POS)	01	02		1			H8095	807	0	2023	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	4	1				0	0	05/02/2022	2023.01	05/02/2022 11:53:04 AM Eastern Daylight Time					06/06/2022 07:13:11 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Group HMOPOS (HMO-POS)	01	02		1			H8095	808	0	2023	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						06/02/2022	2023.01	06/02/2022 12:07:02 PM Eastern Daylight Time		05/25/2022 09:55:27 PM Eastern Daylight Time			06/02/2022 12:08:53 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrapace.com	Centra PACE - Dual (PACE)	08	20		1			H8096	001	0	2023	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						06/02/2022	2023.01	06/02/2022 12:07:31 PM Eastern Daylight Time		05/25/2022 09:59:10 PM Eastern Daylight Time			06/02/2022 12:08:53 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrapace.com	Centra PACE - Medicare only (PACE)	08	20		1			H8096	002	0	2023	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	5	1						08/01/2022	2023.01	08/01/2022 01:09:37 PM Central Daylight Time	08/03/2022 09:09:53 PM Eastern Daylight Time	07/30/2022 10:33:53 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Saint Thomas Access Plus (PPO)	01	04		1			H8121	001	0	2023	Select counties in Central Tennessee		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)906-2876		(833)906-2876		(866)281-2878		(866)281-2878		(833)906-2876		(833)906-2876		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8121	002	0	1	04	01	H8121_002_0	5	1						08/01/2022	2023.01	08/01/2022 01:10:31 PM Central Daylight Time	08/03/2022 09:11:08 PM Eastern Daylight Time	07/30/2022 10:34:25 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Saint Thomas Access (PPO)	01	04		1			H8121	002	0	2023	Select counties in Central Tennessee		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)906-2876		(833)906-2876		(866)281-2878		(866)281-2878		(833)906-2876		(833)906-2876		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8121	801	0	1	04	01	H8121_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:09:31 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H8121	801	0	2023	10 Counties in Central Tennessee		1	100	2			2									In development	In development	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:20:04 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H8121	802	0	2023	10 Counties in Central Tennessee		1	100	2			2									In development	In development	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:20:11 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H8121	803	0	2023	10 Counties in Central Tennessee		1	100	2			2									In development	In development	www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(855)848-6940		(855)848-6940		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H8130	001	0	1	01	01	H8130_001_0	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:37:36 PM Pacific Daylight Time	08/04/2022 06:14:02 PM Pacific Daylight Time	08/01/2022 10:48:48 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1		1			0	08/04/2022	2023.01	08/04/2022 10:27:41 PM Pacific Daylight Time	08/04/2022 06:14:30 PM Pacific Daylight Time	08/01/2022 10:49:22 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	Select Counties in Florida		2		2			1	4			00000000000010000000000					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	9	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:37:58 PM Pacific Daylight Time	08/04/2022 06:14:58 PM Pacific Daylight Time	08/01/2022 10:49:54 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	8	1					1	08/04/2022	2023.01	08/04/2022 02:02:45 PM Pacific Daylight Time	08/04/2022 06:15:28 PM Pacific Daylight Time	08/01/2022 10:50:26 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 01:17:53 PM Pacific Daylight Time	08/04/2022 06:15:58 PM Pacific Daylight Time	08/01/2022 03:33:18 PM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	9	1						08/03/2022	2023.01	08/03/2022 11:26:16 AM Central Daylight Time	08/05/2022 02:35:53 PM Central Daylight Time	08/03/2022 06:34:06 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	001	0	2023	Houston Metro Area		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	003	0	1	01	01	H8133_003_0	7	1						08/03/2022	2023.01	08/03/2022 11:27:12 AM Central Daylight Time	08/05/2022 02:36:59 PM Central Daylight Time	08/03/2022 06:35:28 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	003	0	2023	El Paso		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	005	0	1	01	01	H8133_005_0	7	1						08/03/2022	2023.01	08/03/2022 11:30:23 AM Central Daylight Time	08/05/2022 02:38:22 PM Central Daylight Time	08/03/2022 06:36:49 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	005	0	2023	South Texas		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8142	001	0	1	01	01	H8142_001_0	8	1					1	08/03/2022	2023.01	08/03/2022 02:41:57 PM Central Daylight Time	08/04/2022 09:16:16 AM Central Daylight Time	08/04/2022 09:16:38 AM Central Daylight Time			08/04/2022 09:20:16 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Select Rx (HMO)	01	01		1			H8142	001	0	2023	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	8	1					1	08/03/2022	2023.01	08/03/2022 02:42:33 PM Central Daylight Time	08/04/2022 09:16:16 AM Central Daylight Time	08/04/2022 09:16:38 AM Central Daylight Time			08/04/2022 09:20:16 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Preferred Rx (HMO)	01	01		1			H8142	002	0	2023	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	8	1					1	07/12/2022	2023.01	07/12/2022 08:41:02 AM Central Daylight Time	08/04/2022 09:16:16 AM Central Daylight Time	08/04/2022 09:16:38 AM Central Daylight Time			08/04/2022 09:20:16 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Premium Rx (HMO)	01	01		1			H8142	003	0	2023	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	07/12/2022	2023.01	07/12/2022 08:41:17 AM Central Daylight Time	06/06/2022 10:10:03 PM Central Daylight Time				07/12/2022 08:52:16 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Select (HMO)	01	01		1			H8142	004	0	2023	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	07/12/2022	2023.01	07/12/2022 08:41:34 AM Central Daylight Time	06/06/2022 10:10:03 PM Central Daylight Time				07/12/2022 08:52:16 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Preferred (HMO)	01	01		1			H8142	005	0	2023	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	07/12/2022	2023.01	07/12/2022 08:41:50 AM Central Daylight Time	06/06/2022 10:10:03 PM Central Daylight Time				07/12/2022 08:52:16 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Premium (HMO)	01	01		1			H8142	006	0	2023	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	9	1					1	08/03/2022	2023.01	08/03/2022 02:52:30 PM Central Daylight Time	08/04/2022 09:16:16 AM Central Daylight Time	08/04/2022 09:16:38 AM Central Daylight Time			08/04/2022 09:20:16 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Select Rx (HMO)	01	01		1			H8142	007	0	2023	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	6	1				0	0	07/12/2022	2023.01	07/12/2022 08:42:23 AM Central Daylight Time	06/08/2022 08:25:12 PM Central Daylight Time				07/12/2022 08:52:16 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Select (HMO)	01	01		1			H8142	008	0	2023	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						05/11/2022	2023.01	05/11/2022 01:55:36 PM Central Daylight Time					06/06/2022 10:38:42 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP CY Rx (HMO)	01	01		1			H8142	801	0	2023	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					1				
H8142	802	0	1	01	01	H8142_802_0	3	1				0	0	05/16/2022	2023.01	05/16/2022 11:31:31 AM Central Daylight Time					06/06/2022 10:38:42 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP CY (HMO)	01	01		1			H8142	802	0	2023	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					1				
H8142	803	0	1	01	01	H8142_803_0	3	1						05/16/2022	2023.01	05/16/2022 11:32:26 AM Central Daylight Time					06/06/2022 10:38:42 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP FY Rx (HMO)	01	01		1			H8142	803	0	2023	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					1				
H8142	804	0	1	01	01	H8142_804_0	3	1				0	0	05/16/2022	2023.01	05/16/2022 11:33:19 AM Central Daylight Time					06/06/2022 10:38:42 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP FY (HMO)	01	01		1			H8142	804	0	2023	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					1				
H8145	004	0	1	09	04	H8145_004_0	3	1						05/30/2022	2023.01	05/30/2022 10:08:39 AM Eastern Daylight Time	08/03/2022 04:00:33 PM Eastern Daylight Time	07/30/2022 09:51:20 AM Eastern Daylight Time			08/04/2022 03:15:59 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	2023	North Carolina-Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	3	1						06/02/2022	2023.01	06/02/2022 01:26:21 PM Eastern Daylight Time	08/03/2022 03:50:42 PM Eastern Daylight Time	07/30/2022 09:51:44 AM Eastern Daylight Time			08/04/2022 11:31:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-006 (PFFS)	04	09	1	1			H8145	006	0	2023	Select Counties in Michigan and Wisconsin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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						05/31/2022	2023.01	05/31/2022 02:21:49 PM Eastern Daylight Time	08/03/2022 03:45:06 PM Eastern Daylight Time	07/30/2022 09:52:10 AM Eastern Daylight Time			08/04/2022 11:31:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-008 (PFFS)	04	09	1	1			H8145	008	0	2023	Select Counties in Illinois		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	5	1						06/01/2022	2023.01	06/01/2022 11:51:20 AM Eastern Daylight Time	08/03/2022 04:27:52 PM Eastern Daylight Time	07/30/2022 09:52:36 AM Eastern Daylight Time			08/04/2022 12:19:29 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	2023	Select counties in Ohio and Indiana		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1				0	0	05/30/2022	2023.01	05/30/2022 10:26:53 AM Eastern Daylight Time	07/18/2022 05:09:29 PM Eastern Daylight Time				07/20/2022 02:57:29 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	2023	Select Counties in Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	3	1						08/01/2022	2023.01	08/01/2022 12:55:34 PM Eastern Daylight Time	08/03/2022 04:32:01 PM Eastern Daylight Time	07/30/2022 09:53:02 AM Eastern Daylight Time			08/04/2022 05:11:45 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	2023	Select Counties in KY, PA, WV		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1				0	0	05/30/2022	2023.01	05/30/2022 08:23:44 PM Eastern Daylight Time	07/18/2022 04:42:29 PM Eastern Daylight Time				07/20/2022 01:34:11 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	2023	Pennsylvania and West Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	069	0	1	09	04	H8145_069_0	3	1						08/01/2022	2023.01	08/01/2022 07:02:11 PM Eastern Daylight Time	08/03/2022 05:27:35 PM Eastern Daylight Time	07/30/2022 09:53:28 AM Eastern Daylight Time			08/04/2022 03:56:59 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	2023	Select Counties in Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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						05/30/2022	2023.01	05/30/2022 08:05:56 PM Eastern Daylight Time	08/03/2022 03:40:16 PM Eastern Daylight Time	07/30/2022 09:53:52 AM Eastern Daylight Time			08/04/2022 01:48:32 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	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	3	1						05/30/2022	2023.01	05/30/2022 09:46:13 AM Eastern Daylight Time	08/03/2022 03:40:52 PM Eastern Daylight Time	07/30/2022 09:54:18 AM Eastern Daylight Time			08/04/2022 12:44:49 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	2023	Select Counties in IA, MN, MT, ND, SD, WY		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	5	1						06/02/2022	2023.01	06/02/2022 07:04:01 PM Eastern Daylight Time	08/03/2022 03:36:20 PM Eastern Daylight Time	07/30/2022 09:54:44 AM Eastern Daylight Time			08/04/2022 12:45:32 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	2023	Select Counties in Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	6	1				0	0	05/31/2022	2023.01	05/31/2022 01:43:30 PM Eastern Daylight Time	07/26/2022 03:09:22 PM Eastern Daylight Time				07/28/2022 11:48:50 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-120 (PFFS)	04	09	1	1			H8145	120	0	2023	Select Counties in AR, KS, MO and OK		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1				0	0	05/28/2022	2023.01	05/28/2022 11:03:29 AM Eastern Daylight Time	07/18/2022 04:57:23 PM Eastern Daylight Time				07/20/2022 01:34:14 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	2023	Select Counties in Illinois		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	122	0	1	09	04	H8145_122_0	3	1						05/28/2022	2023.01	05/28/2022 09:34:28 AM Eastern Daylight Time	08/03/2022 03:39:47 PM Eastern Daylight Time	07/30/2022 09:55:08 AM Eastern Daylight Time			08/04/2022 11:21:39 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-122 (PFFS)	04	09	1	1			H8145	122	0	2023	Select Counties in AR, KS, MO, OK, and IL		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	3	1						05/29/2022	2023.01	05/29/2022 02:48:40 PM Eastern Daylight Time	08/03/2022 03:41:03 PM Eastern Daylight Time	07/30/2022 09:55:34 AM Eastern Daylight Time			08/04/2022 03:15:16 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	2023	Select Counties in Colorado and New Mexico		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	125	0	1	09	04	H8145_125_0	4	1						05/31/2022	2023.01	05/31/2022 02:40:14 PM Eastern Daylight Time	08/03/2022 03:40:16 PM Eastern Daylight Time	07/30/2022 09:56:00 AM Eastern Daylight Time			08/04/2022 11:21:39 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-125 (PFFS)	04	09	1	1			H8145	125	0	2023	Select Counties in Kansas, Missouri, and Oklahoma		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	05/28/2022	2023.01	05/28/2022 10:28:16 AM Eastern Daylight Time	07/18/2022 05:03:44 PM Eastern Daylight Time				07/20/2022 03:33:20 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	2023	Select Counties in Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	5	1						08/02/2022	2023.01	08/02/2022 01:25:19 PM Eastern Daylight Time	08/02/2022 04:39:16 PM Eastern Daylight Time	08/01/2022 01:03:34 PM Eastern Daylight Time			08/04/2022 11:24:24 AM Eastern Daylight Time	HIGHMARK BCBSD, INC.	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Signature (PPO)	01	04		1			H8166	001	0	2023	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	5	1					1	08/04/2022	2023.01	08/04/2022 11:01:28 AM Eastern Daylight Time	08/03/2022 11:58:57 AM Eastern Daylight Time	08/01/2022 12:38:54 PM Eastern Daylight Time			08/04/2022 11:24:24 AM Eastern Daylight Time	HIGHMARK BCBSD, INC.	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Distinct (PPO)	01	04		1			H8166	002	0	2023	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	003	0	1	04	01	H8166_003_0	4	1				0	0	07/15/2022	2023.01	07/15/2022 09:04:52 PM Eastern Daylight Time	07/14/2022 06:21:27 PM Eastern Daylight Time				07/19/2022 03:32:44 PM Eastern Daylight Time	HIGHMARK BCBSD, INC.	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Valor (PPO)	01	04		1			H8166	003	0	2023	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8166	801	0	1	04	01	H8166_801_0	1	1				0	0	06/02/2022	2023.01	06/02/2022 02:00:53 PM Eastern Daylight Time					06/03/2022 03:31:02 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	2023	Delaware		1	340800	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;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						06/02/2022	2023.01	06/02/2022 02:20:23 PM Eastern Daylight Time					06/03/2022 03:31:02 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	2023	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;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						06/02/2022	2023.01	06/02/2022 02:01:33 PM Eastern Daylight Time					06/03/2022 03:31:02 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	2023	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;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	804	0	1	04	01	H8166_804_0	1	1						06/02/2022	2023.01	06/02/2022 02:01:53 PM Eastern Daylight Time					06/03/2022 03:31:02 PM Eastern Daylight Time	HIGHMARK BCBSD, INC.	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD DE ASO CALENDAR (PPO)	01	04		1			H8166	804	0	2023	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;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	10	1					0	08/03/2022	2023.01	08/03/2022 03:34:27 PM US Eastern Daylight Time	08/04/2022 09:52:24 AM Eastern Daylight Time	07/31/2022 02:04:36 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Arizona (HMO)	01	01		1			H8173	001	0	2023	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	10	1					0	07/21/2022	2023.01	07/21/2022 03:25:08 PM US Eastern Daylight Time	08/04/2022 09:52:52 AM Eastern Daylight Time	07/31/2022 02:04:58 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted SELECT Arizona (HMO)	01	01		1			H8173	002	0	2023	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	005	0	1	01	01	H8173_005_0	10	1				0	0	07/25/2022	2023.01	07/25/2022 07:36:44 PM US Eastern Daylight Time	07/11/2022 12:16:19 PM Eastern Daylight Time				07/25/2022 08:46:49 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted LIBERTY Arizona (HMO)	01	01		1			H8173	005	0	2023	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	007	0	1	01	01	H8173_007_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:36:44 PM US Eastern Daylight Time	08/04/2022 09:53:50 AM Eastern Daylight Time	07/31/2022 02:05:19 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted CORE Arizona (HMO)	01	01		1			H8173	007	0	2023	Yavapai and Coconino 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	008	0	1	01	01	H8173_008_0	10	1					1	07/21/2022	2023.01	07/21/2022 03:36:21 PM US Eastern Daylight Time	08/04/2022 09:54:16 AM Eastern Daylight Time	07/31/2022 02:05:41 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted SELECT Arizona (HMO)	01	01		1			H8173	008	0	2023	Yavapai and Coconino 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	011	0	1	01	01	H8173_011_0	9	1		1			1	08/03/2022	2023.01	08/03/2022 03:37:16 PM US Eastern Daylight Time	08/04/2022 09:54:45 AM Eastern Daylight Time	07/31/2022 02:06:03 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted BEWELL Arizona (HMO C-SNP)	01	01		1			H8173	011	0	2023	Maricopa and Pinal Counties		2		2			1	4			00000000000000000010000					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	013	0	1	01	01	H8173_013_0	11	1					0	08/03/2022	2023.01	08/03/2022 03:37:34 PM US Eastern Daylight Time	08/04/2022 10:00:04 AM Eastern Daylight Time	07/31/2022 02:06:24 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted GIVEBACK Arizona (HMO)	01	01		1			H8173	013	0	2023	Pima 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			
H8173	014	0	1	01	01	H8173_014_0	9	1		1			0	07/21/2022	2023.01	07/21/2022 03:48:00 PM US Eastern Daylight Time	08/04/2022 09:55:16 AM Eastern Daylight Time	07/31/2022 02:06:46 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted BEWELL PLUS Arizona (HMO C-SNP)	01	01		1			H8173	014	0	2023	Maricopa and Pinal Counties		2		2			1	4			00000000000000000010000					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	015	0	1	01	01	H8173_015_0	5	1		1			0	07/21/2022	2023.01	07/21/2022 03:54:02 PM US Eastern Daylight Time	08/04/2022 09:55:49 AM Eastern Daylight Time	07/31/2022 02:07:07 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted BEWELL PLUS Arizona (HMO C-SNP)	01	01		1			H8173	015	0	2023	Yavapai and Coconino Counties		2		2			1	4			00000000000000000010000					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	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:38:23 PM Pacific Daylight Time	08/04/2022 06:16:26 PM Pacific Daylight Time	08/01/2022 10:51:30 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	6	1					1	08/04/2022	2023.01	08/04/2022 02:05:10 PM Pacific Daylight Time	08/04/2022 06:16:52 PM Pacific Daylight Time	08/01/2022 10:52:04 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1						08/04/2022	2023.01	08/04/2022 09:04:24 AM Eastern Daylight Time	08/04/2022 01:24:36 PM Eastern Daylight Time	08/04/2022 01:25:18 PM Eastern Daylight Time			08/05/2022 09:14:21 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	2023	Omaha/ Lincoln Metro Area and Central Nebraska		2		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	002	0	1	04	01	H8181_002_0	7	1						08/04/2022	2023.01	08/04/2022 09:06:26 AM Eastern Daylight Time	08/04/2022 01:24:42 PM Eastern Daylight Time	08/04/2022 01:25:24 PM Eastern Daylight Time			08/05/2022 09:14:21 AM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	https://Medicare.NebraskaBlue.com	Blue Cross Blue Shield Nebraska MA Connect PPO (PPO)	01	04		1			H8181	002	0	2023	Omaha/ Lincoln Metro Area and Central Nebraska		2		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	4	1						05/06/2022	2023.01	05/06/2022 09:06:38 AM Eastern Daylight Time					06/06/2022 01:18:06 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	2023	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	802	0	1	04	01	H8181_802_0	4	1				0	0	05/06/2022	2023.01	05/06/2022 09:28:12 AM Eastern Daylight Time					06/06/2022 01:18:06 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	2023	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	4	1						05/06/2022	2023.01	05/06/2022 09:28:59 AM Eastern Daylight Time					06/06/2022 01:18:06 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	2023	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	4	1						05/06/2022	2023.01	05/06/2022 09:29:35 AM Eastern Daylight Time					06/06/2022 01:18:06 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	2023	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	1		0	08/04/2022	2023.01	08/04/2022 11:27:50 AM Eastern Daylight Time	08/03/2022 09:08:22 PM Eastern Daylight Time	07/30/2022 10:34:57 AM Eastern Daylight Time			08/04/2022 05:23:51 PM Eastern Daylight Time	MANAGED HEALTH SERVICES INSURANCE CORP.	Wellcare by Allwell	www.wellcare.com/allwellWI	Wellcare Dual Access (HMO D-SNP)	01	01		1			H8189	001	0	2023	Select counties in WI		2		2			1	3		1					1	www.wellcare.com/allwellWI	www.wellcare.com/allwellWI	www.wellcare.com/allwellWI	(877)935-8024		(877)935-8024		(844)917-0175		(844)917-0175		(877)935-8024		(877)935-8024		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8197	002	1	1	48	05	H8197_002_1	4	1						09/07/2022	2023.01	09/07/2022 02:06:51 PM Pacific Daylight Time					09/07/2022 03:03:43 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	2023	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	4	1						09/07/2022	2023.01	09/07/2022 02:11:16 PM Pacific Daylight Time					09/07/2022 03:03:43 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	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 05:06:32 PM Central Daylight Time	08/03/2022 10:26:33 AM Central Daylight Time	07/31/2022 03:48:44 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H8211	001	0	2023	State of 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	2	1					1	06/01/2022	2023.01	06/01/2022 02:48:04 PM Central Daylight Time	08/03/2022 10:27:30 AM Central Daylight Time	07/31/2022 03:49:08 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H8211	002	0	2023	State of 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	1	1				0	0	05/31/2022	2023.01	05/31/2022 10:20:44 AM Central Daylight Time	06/01/2022 12:02:33 PM Central Daylight Time				06/02/2022 01:46:46 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8211	005	0	2023	State of 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	2	1					1	08/02/2022	2023.01	08/02/2022 01:14:57 PM Central Daylight Time	08/03/2022 10:28:10 AM Central Daylight Time	07/31/2022 03:49:33 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Flex (PPO)	01	04		1			H8211	006	0	2023	State of 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	2	1					1	06/01/2022	2023.01	06/01/2022 02:47:27 PM Central Daylight Time	08/03/2022 10:28:48 AM Central Daylight Time	07/31/2022 03:49:58 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H8211	007	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 02:33:51 PM Central Daylight Time	08/03/2022 10:29:26 AM Central Daylight Time	07/31/2022 03:50:23 AM Central Daylight Time			08/04/2022 02:12:03 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H8211	009	0	2023	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	1	1				0	0	05/31/2022	2023.01	05/31/2022 11:23:43 PM Central Daylight Time	06/01/2022 12:04:58 PM Central Daylight Time				06/02/2022 01:13:21 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8211	010	0	2023	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	6	1						10/27/2022	2023.01	10/27/2022 02:30:58 PM Eastern Daylight Time					10/27/2022 03:11:55 PM Eastern 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	2023	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	5	1						08/01/2022	2023.01	08/01/2022 01:14:05 PM Central Daylight Time	08/03/2022 09:12:24 PM Eastern Daylight Time	07/30/2022 10:35:29 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Florida Reward (HMO)	01	01		1			H8225	001	0	2023	Select counties in Florida		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	003	0	1	01	01	H8225_003_0	5	1						08/01/2022	2023.01	08/01/2022 01:12:57 PM Central Daylight Time	08/03/2022 09:13:39 PM Eastern Daylight Time	07/30/2022 10:36:01 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent's Secure (HMO)	01	01		1			H8225	003	0	2023	Jacksonville Metro Area		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	004	0	1	01	01	H8225_004_0	5	1						08/01/2022	2023.01	08/01/2022 01:15:03 PM Central Daylight Time	08/03/2022 09:14:56 PM Eastern Daylight Time	07/30/2022 10:36:32 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Sacred Heart Secure (HMO)	01	01		1			H8225	004	0	2023	Pensacola Metro Area		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	005	0	1	01	01	H8225_005_0	5	1	2	1			0	07/15/2022	2023.01	07/15/2022 08:50:54 AM Central Daylight Time	08/03/2022 09:16:13 PM Eastern Daylight Time	07/30/2022 10:37:05 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent's DSNP (HMO D-SNP)	01	01		1			H8225	005	0	2023	Jacksonville Metro Area		2		2			1	3		1					1	www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	006	0	1	01	01	H8225_006_0	5	1	2	1			0	07/14/2022	2023.01	07/14/2022 09:37:08 AM Central Daylight Time	08/03/2022 09:17:28 PM Eastern Daylight Time	07/30/2022 10:37:37 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Sacred Heart DSNP (HMO D-SNP)	01	01		1			H8225	006	0	2023	Pensacola Area		2		2			1	3		1					1	www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	007	0	1	02	01	H8225_007_0	5	1						08/01/2022	2023.01	08/01/2022 01:16:32 PM Central Daylight Time	08/03/2022 09:18:43 PM Eastern Daylight Time	07/30/2022 10:38:09 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent's Access POS (HMO-POS)	01	02		1			H8225	007	0	2023	Jacksonville Metro Area		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	008	0	1	02	01	H8225_008_0	5	1						08/01/2022	2023.01	08/01/2022 01:19:10 PM Central Daylight Time	08/03/2022 09:19:58 PM Eastern Daylight Time	07/30/2022 10:38:40 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Sacred Heart Access POS (HMO-POS)	01	02		1			H8225	008	0	2023	Pensacola Area		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	009	0	1	01	01	H8225_009_0	6	1						08/01/2022	2023.01	08/01/2022 01:20:22 PM Central Daylight Time	08/03/2022 09:21:12 PM Eastern Daylight Time	07/30/2022 10:39:12 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Florida Reward II (HMO)	01	01		1			H8225	009	0	2023	Select Counties in Florida		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(833)603-2971		(833)603-2971		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8229	001	0	1	04	01	H8229_001_0	6	1					1	08/02/2022	2023.01	08/02/2022 03:35:13 PM Central Daylight Time	08/05/2022 05:23:19 AM Central Daylight Time	08/05/2022 05:22:49 AM Central Daylight Time			08/05/2022 05:49:32 AM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Choice (PPO)	01	04		1			H8229	001	0	2023	Northeast Georgia		2		2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8229	801	0	1	04	01	H8229_801_0	2	1						06/02/2022	2023.01	06/02/2022 11:57:50 AM Central Daylight Time					06/03/2022 12:38:34 PM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD Calendar Year (PPO)	01	04		1			H8229	801	0	2023	Northeast Georgia		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H8229	802	0	1	04	01	H8229_802_0	2	1						06/02/2022	2023.01	06/02/2022 11:57:31 AM Central Daylight Time					06/03/2022 12:38:34 PM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD non-Calendar Year (PPO)	01	04		1			H8229	802	0	2023	Northeast Georgia		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H8229	803	0	1	04	01	H8229_803_0	2	1				0	0	06/02/2022	2023.01	06/02/2022 11:58:24 AM Central Daylight Time					06/03/2022 12:38:34 PM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only Calendar Year (PPO)	01	04		1			H8229	803	0	2023	Northeast Georgia		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;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									
H8229	804	0	1	04	01	H8229_804_0	2	1				0	0	06/02/2022	2023.01	06/02/2022 11:59:03 AM Central Daylight Time					06/03/2022 12:38:34 PM Central Daylight Time	ESSENCE HEALTHCARE OF GEORGIA, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only non-Calendar Year (PPO)	01	04		1			H8229	804	0	2023	Northeast Georgia		1	300	2			2									https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(855)425-0457		(855)425-0457		(855)945-0189		(855)945-0189										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H8244	001	0	1	04	01	H8244_001_0	3	1	2	1			0	07/11/2022	2023.01	07/11/2022 09:49:47 AM Pacific Daylight Time	08/05/2022 02:17:35 PM Pacific Daylight Time	08/02/2022 10:59:52 AM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Duals (PPO D-SNP)	01	04		1			H8244	001	0	2023	Clark, Washoe, Nye, Storey, Douglas & Carson City		2		2			1	3		1					1	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			
H8293	001	0	1	01	01	H8293_001_0	5	1					1	08/03/2022	2023.01	08/03/2022 08:01:47 AM Central Daylight Time	08/04/2022 03:23:17 PM Central Daylight Time	08/04/2022 03:33:47 PM Central Daylight Time			08/04/2022 04:25:51 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	2023	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	6	1	2	1			0	08/01/2022	2023.01	08/01/2022 02:52:03 PM Eastern Daylight Time	08/04/2022 07:52:54 AM Eastern Daylight Time	08/04/2022 07:52:17 AM Eastern Daylight Time			08/04/2022 08:19:10 AM 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	2023	New Jersey		2		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	08/02/2022	2023.01	08/02/2022 04:33:20 PM Eastern Daylight Time	08/03/2022 11:50:42 AM Eastern Daylight Time	08/02/2022 02:22:56 PM Eastern Daylight Time			08/05/2022 12:05:01 PM 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	2023	Most of Massachusetts		2		2			1	3		1					1	www.tuftsmedicarepreferred.org/tufts-health-plan-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			
H8330	002	0	1	01	01	H8330_002_0	7	1	2	1			0	08/02/2022	2023.01	08/02/2022 03:58:27 PM Eastern Daylight Time	08/03/2022 11:51:06 AM Eastern Daylight Time	08/02/2022 02:23:16 PM Eastern Daylight Time			08/05/2022 12:05:01 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/sco	Tufts Health Plan Senior Care Options CW (HMO D-SNP)	01	01		1			H8330	002	0	2023	Most of Massachusetts		2		2			1	3		1					1	www.tuftsmedicarepreferred.org/tufts-health-plan-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	3	1						08/01/2022	2023.01	08/01/2022 07:57:55 PM Central Daylight Time	08/02/2022 02:03:38 PM Central Daylight Time	07/31/2022 11:49:10 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H8332	001	0	2023	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						08/01/2022	2023.01	08/01/2022 06:20:13 PM Central Daylight Time	08/02/2022 02:04:39 PM Central Daylight Time	07/31/2022 11:49:38 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H8332	002	0	2023	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						08/01/2022	2023.01	08/01/2022 06:20:48 PM Central Daylight Time	08/02/2022 02:05:43 PM Central Daylight Time	07/31/2022 11:50:04 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H8332	003	0	2023	Houston 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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8332	004	0	1	01	01	H8332_004_0	2	1						08/01/2022	2023.01	08/01/2022 06:21:28 PM Central Daylight Time	08/02/2022 02:06:45 PM Central Daylight Time	07/31/2022 11:50:30 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H8332	004	0	2023	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	2			
H8332	005	0	1	01	01	H8332_005_0	2	1						08/01/2022	2023.01	08/01/2022 06:22:04 PM Central Daylight Time	08/02/2022 02:07:45 PM Central Daylight Time	07/31/2022 11:50:56 PM Central Daylight Time			08/04/2022 04:14:12 PM Central Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H8332	005	0	2023	Austin		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(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	05/30/2022	2023.01	05/30/2022 10:48:45 AM Eastern Daylight Time					06/02/2022 03:42:41 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	2023	Texas		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H8332	802	0	1	01	01	H8332_802_0	1	1						05/30/2022	2023.01	05/30/2022 10:49:29 AM Eastern Daylight Time					06/02/2022 03:42:41 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	2023	Texas		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H8343	001	0	1	04	01	H8343_001_0	5	1					0	08/04/2022	2023.01	08/04/2022 04:42:33 PM Pacific Daylight Time	08/04/2022 03:20:19 PM Pacific Daylight Time	08/04/2022 03:36:49 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	001	0	2023	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	6	1					0	08/04/2022	2023.01	08/04/2022 04:43:11 PM Pacific Daylight Time	08/04/2022 03:20:20 PM Pacific Daylight Time	08/04/2022 03:36:52 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	002	0	2023	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	5	1					0	08/04/2022	2023.01	08/04/2022 04:43:41 PM Pacific Daylight Time	08/04/2022 03:20:22 PM Pacific Daylight Time	08/04/2022 03:36:54 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	003	0	2023	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					1	08/01/2022	2023.01	08/01/2022 04:47:20 PM Eastern Daylight Time	08/04/2022 06:21:36 PM Eastern Daylight Time	08/04/2022 06:39:14 PM Eastern Daylight Time			08/04/2022 07:09:53 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	007	0	2023	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			
H8343	009	0	1	04	01	H8343_009_0	6	1					0	07/12/2022	2023.01	07/12/2022 10:27:43 AM Eastern Daylight Time	08/04/2022 06:23:23 PM Eastern Daylight Time	08/04/2022 06:42:40 PM Eastern Daylight Time			08/04/2022 08:16:16 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	009	0	2023	Pima 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	010	0	1	04	01	H8343_010_0	5	1					1	08/01/2022	2023.01	08/01/2022 04:06:17 PM Eastern Daylight Time	08/04/2022 06:17:20 PM Eastern Daylight Time	08/04/2022 06:31:07 PM Eastern Daylight Time			08/04/2022 09:35:16 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	010	0	2023	Select counties in TN		2		2			2									https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.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			
H8343	011	0	1	04	01	H8343_011_0	4	1				0	0	05/24/2022	2023.01	05/24/2022 11:45:39 AM Eastern Daylight Time	07/19/2022 05:09:30 PM Eastern Daylight Time				07/19/2022 07:50:24 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Courage (PPO)	01	04		1			H8343	011	0	2023	Select counties in TN		2		2			2									https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1073		(833)713-1073		(855)679-0561		(855)679-0561										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8379	001	0	1	01	01	H8379_001_0	16	1	2	1			0	08/03/2022	2023.01	08/03/2022 03:56:05 PM Eastern Daylight Time	08/04/2022 01:35:18 PM Eastern Daylight Time	07/31/2022 07:35:06 AM Eastern Daylight Time			08/04/2022 09:01:07 PM 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	2023	68 lower peninsula Michigan counties		2		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			
H8379	002	0	1	01	01	H8379_002_0	16	1	2	1			0	08/03/2022	2023.01	08/03/2022 08:45:52 PM Eastern Daylight Time	08/04/2022 12:52:18 PM Eastern Daylight Time	07/31/2022 07:35:24 AM Eastern Daylight Time			08/04/2022 09:01:07 PM Eastern Daylight Time	PRIORITY HEALTH CHOICE, INC.	Priority Health Medicare	www.priorityhealth.com/dsnp	PriorityMedicare D-SNP + Kroger (HMO D-SNP)	01	01		1			H8379	002	0	2023	GEN, ING, LIV, MAC, OAK, SAG, WASH, WAY counties		2		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			
H8384	801	0	1	01	01	H8384_801_0	1	1		1				06/06/2022	2023.01	06/06/2022 09:52:39 AM Central Daylight Time					06/06/2022 01:08:56 PM Central Daylight Time	HONEST HMO OF MICHIGAN LLC	Honest Health Plan	www.honesthealthplan.com	HonestCare Empower (HMO C-SNP)	01	01		1			H8384	801	0	2023	Detroit Area		1	84683	2			1	4			00000000000000000010000					www.honesthealthplan.com	www.honesthealthplan.com	www.honesthealthplan.com	(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;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					2				
H8384	802	0	1	01	01	H8384_802_0	2	1		1				06/05/2022	2023.01	06/05/2022 03:25:47 PM Central Daylight Time					08/19/2022 10:34:14 AM Central Daylight Time	HONEST HMO OF MICHIGAN LLC	Honest Health Plan	www.honesthealthplan.com	HonestCare Embrace (HMO C-SNP)	01	01		1			H8384	802	0	2023	Detroit Area		1	2121	2			1	4			00000000100000000000000					www.honesthealthplan.com	www.honesthealthplan.com	www.honesthealthplan.com	(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;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					2				
H8384	803	0	1	01	01	H8384_803_0	1	1		1				06/05/2022	2023.01	06/05/2022 03:26:08 PM Central Daylight Time					06/06/2022 01:08:56 PM Central Daylight Time	HONEST HMO OF MICHIGAN LLC	Honest Health Plan	www.honesthealthplan.com	HonestCare Empower (HMO C-SNP)	01	01		1			H8384	803	0	2023	Detroit Area		1	84683	2			1	4			00000000000000000010000					www.honesthealthplan.com	www.honesthealthplan.com	www.honesthealthplan.com	(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;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					2				
H8384	804	0	1	01	01	H8384_804_0	2	1		1				06/05/2022	2023.01	06/05/2022 03:26:28 PM Central Daylight Time					08/19/2022 10:34:14 AM Central Daylight Time	HONEST HMO OF MICHIGAN LLC	Honest Health Plan	www.honesthealthplan.com	HonestCare Embrace (HMO C-SNP)	01	01		1			H8384	804	0	2023	Detroit Area		1	2121	2			1	4			00000000100000000000000					www.honesthealthplan.com	www.honesthealthplan.com	www.honesthealthplan.com	(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(833)271-9112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;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					2				
H8385	001	0	1	04	01	H8385_001_0	5	1					1	08/03/2022	2023.01	08/03/2022 02:35:52 PM Central Daylight Time	08/03/2022 11:47:04 AM Central Daylight Time	08/02/2022 11:31:00 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	SANFORD HEALTH PLAN	Sanford Health Plan	www.align.sanfordhealthplan.com	Align ChoiceElite (PPO)	01	04		1			H8385	001	0	2023	South Dakota		2		2			2									www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	(888)278-6485		(888)278-6485		(888)605-9277		(605)328-7200		(844)642-9090		(844)642-9090		(888)605-9277		(605)328-7200		(888)279-1549		(888)279-1549		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8385	002	0	1	04	01	H8385_002_0	6	1					1	08/03/2022	2023.01	08/03/2022 02:35:42 PM Central Daylight Time	08/03/2022 04:51:13 PM Central Daylight Time	08/11/2022 09:28:57 AM Central Daylight Time			08/11/2022 03:11:50 PM Central Daylight Time	SANFORD HEALTH PLAN	Sanford Health Plan	www.align.sanfordhealthplan.com	Align ChoiceElite (PPO)	01	04		1			H8385	002	0	2023	North Dakota		2		2			2									www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	(888)278-6485		(888)278-6485		(888)605-9277		(605)328-7200		(844)642-9090		(844)642-9090		(888)605-9277		(605)328-7200		(888)279-1549		(888)279-1549		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8385	003	0	1	04	01	H8385_003_0	5	1					1	08/03/2022	2023.01	08/03/2022 02:36:11 PM Central Daylight Time	08/03/2022 11:48:13 AM Central Daylight Time	08/02/2022 11:33:54 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	SANFORD HEALTH PLAN	Sanford Health Plan	www.align.sanfordhealthplan.com	Align ChoicePlus (PPO)	01	04		1			H8385	003	0	2023	South Dakota		2		2			2									www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	(888)278-6485		(888)278-6485		(888)605-9277		(605)328-7200		(844)642-9090		(844)642-9090		(888)605-9277		(605)328-7200		(888)279-1549		(888)279-1549		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8385	004	0	1	04	01	H8385_004_0	5	1					1	08/03/2022	2023.01	08/03/2022 02:37:39 PM Central Daylight Time	08/03/2022 11:48:47 AM Central Daylight Time	08/02/2022 11:35:20 AM Central Daylight Time			08/04/2022 12:49:43 PM Central Daylight Time	SANFORD HEALTH PLAN	Sanford Health Plan	www.align.sanfordhealthplan.com	Align ChoicePlus (PPO)	01	04		1			H8385	004	0	2023	North Dakota		2		2			2									www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	www.align.sanfordhealthplan.com	(888)278-6485		(888)278-6485		(888)605-9277		(605)328-7200		(844)642-9090		(844)642-9090		(888)605-9277		(605)328-7200		(888)279-1549		(888)279-1549		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8390	015	0	1	01	01	H8390_015_0	8	1	2	1			0	08/02/2022	2023.01	08/02/2022 11:37:47 AM Central Daylight Time	08/03/2022 09:57:40 AM Central Daylight Time	08/03/2022 09:42:36 AM Central Daylight Time			08/05/2022 01:43:08 PM Central Daylight Time	CARESOURCE GEORGIA CO.	CareSource	www.caresource.com/ga/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H8390	015	0	2023	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	8	1	2	1			0	08/03/2022	2023.01	08/03/2022 09:30:36 AM Central Daylight Time	08/03/2022 10:07:08 AM Central Daylight Time	08/03/2022 09:41:20 AM Central Daylight Time			08/05/2022 01:43:08 PM Central Daylight Time	CARESOURCE GEORGIA CO.	CareSource	www.caresource.com/ga/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H8390	016	0	2023	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			
H8424	001	0	1	20	08	H8424_001_0	1	1						06/01/2022	2023.01	06/01/2022 12:08:03 PM Central Daylight Time		05/31/2022 02:41:54 PM Central Daylight Time			06/01/2022 12:11:16 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	2023	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						06/01/2022	2023.01	06/01/2022 12:09:18 PM Central Daylight Time		05/31/2022 02:43:35 PM Central Daylight Time			06/01/2022 12:11:16 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	2023	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	5	1	2	1	1		0	07/08/2022	2023.01	07/08/2022 09:58:52 AM Eastern Daylight Time	08/04/2022 06:15:28 PM Eastern Daylight Time	08/04/2022 06:27:34 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 10:26:51 AM Eastern Daylight Time	08/04/2022 06:18:12 PM Eastern Daylight Time	08/04/2022 06:32:44 PM Eastern Daylight Time			08/04/2022 07:47:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	008	5	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 10:27:00 AM Eastern Daylight Time	08/04/2022 06:18:13 PM Eastern Daylight Time	08/04/2022 06:32:47 PM Eastern Daylight Time			08/04/2022 07:47:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	008	6	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 10:27:12 AM Eastern Daylight Time	08/04/2022 06:18:15 PM Eastern Daylight Time	08/04/2022 06:32:50 PM Eastern Daylight Time			08/04/2022 07:47:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	008	7	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 10:27:23 AM Eastern Daylight Time	08/04/2022 06:18:16 PM Eastern Daylight Time	08/04/2022 06:32:52 PM Eastern Daylight Time			08/04/2022 07:47:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	009	0	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 10:27:35 AM Eastern Daylight Time	08/04/2022 06:18:17 PM Eastern Daylight Time	08/04/2022 06:32:55 PM Eastern Daylight Time			08/04/2022 07:47:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	010	0	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 10:27:46 AM Eastern Daylight Time	08/04/2022 06:18:19 PM Eastern Daylight Time	08/04/2022 06:32:58 PM Eastern Daylight Time			08/04/2022 07:47:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	011	0	2023	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	7	1			2			07/11/2022	2023.01	07/11/2022 10:28:02 AM Eastern Daylight Time	08/04/2022 06:18:20 PM Eastern Daylight Time	08/04/2022 06:33:00 PM Eastern Daylight Time			08/04/2022 07:47:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Choice (HMO-POS)	01	02		1			H8432	015	0	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 10:28:13 AM Eastern Daylight Time	08/04/2022 06:18:22 PM Eastern Daylight Time	08/04/2022 06:33:03 PM Eastern Daylight Time			08/04/2022 07:47:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	01	01		1			H8432	016	0	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 10:28:24 AM Eastern Daylight Time	08/04/2022 06:18:23 PM Eastern Daylight Time	08/04/2022 06:33:06 PM Eastern Daylight Time			08/04/2022 07:47:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	01	01		1			H8432	027	0	2023	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	5	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 01:58:02 PM Eastern Daylight Time	08/04/2022 06:15:29 PM Eastern Daylight Time	08/04/2022 06:27:36 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	034	0	1	01	01	H8432_034_0	6	1	2	1	1		0	08/09/2022	2023.01	08/09/2022 04:28:09 PM Eastern Daylight Time	08/04/2022 06:15:30 PM Eastern Daylight Time	08/04/2022 06:27:39 PM Eastern Daylight Time			08/09/2022 04:34:10 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	2023	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	7	1			2			08/01/2022	2023.01	08/01/2022 12:35:54 PM Eastern Daylight Time	08/04/2022 06:18:24 PM Eastern Daylight Time	08/04/2022 06:33:08 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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			2	0	0	07/11/2022	2023.01	07/11/2022 10:28:56 AM Eastern Daylight Time	08/04/2022 06:18:26 PM Eastern Daylight Time				08/05/2022 08:34:16 AM 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	2023	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	5	1			2	0	0	07/11/2022	2023.01	07/11/2022 10:29:06 AM Eastern Daylight Time	08/04/2022 06:18:27 PM Eastern Daylight Time				08/05/2022 08:34:16 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Service (HMO)	01	01		1			H8432	037	1	2023	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			2	0	0	07/11/2022	2023.01	07/11/2022 10:29:18 AM Eastern Daylight Time	08/04/2022 06:18:28 PM Eastern Daylight Time				08/05/2022 08:34:16 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Service (HMO)	01	01		1			H8432	037	2	2023	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	5	1			2			08/01/2022	2023.01	08/01/2022 12:36:58 PM Eastern Daylight Time	08/04/2022 06:18:29 PM Eastern Daylight Time	08/04/2022 06:33:11 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2			08/01/2022	2023.01	08/01/2022 01:10:31 PM Eastern Daylight Time	08/04/2022 06:18:30 PM Eastern Daylight Time	08/04/2022 06:33:14 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1	2	1	1		0	06/01/2022	2023.01	06/01/2022 11:56:27 AM Eastern Daylight Time	08/04/2022 06:15:32 PM Eastern Daylight Time	08/04/2022 06:27:42 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	6	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 08:00:08 PM Eastern Daylight Time	08/04/2022 06:15:33 PM Eastern Daylight Time	08/04/2022 06:27:45 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	2	1						05/20/2022	2023.01	05/20/2022 09:36:56 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	802	0	1	01	01	H8432_802_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:41:26 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	803	0	2	01	01	H8432_803_0	2	1						05/20/2022	2023.01	05/20/2022 09:42:20 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	804	0	1	01	01	H8432_804_0	2	1						05/20/2022	2023.01	05/20/2022 09:43:08 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	805	0	1	01	01	H8432_805_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:44:44 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	806	0	2	01	01	H8432_806_0	2	1						05/20/2022	2023.01	05/20/2022 09:45:18 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	807	0	2	01	01	H8432_807_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:46:24 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	809	0	1	01	01	H8432_809_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:47:22 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	811	0	2	01	01	H8432_811_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:48:15 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	813	0	1	01	01	H8432_813_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:49:13 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	815	0	2	01	01	H8432_815_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:50:52 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8432	816	0	2	01	01	H8432_816_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:52:05 AM Pacific Daylight Time					06/03/2022 10:52:48 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H8452	001	0	1	48	05	H8452_001_0	4	1						07/18/2022	2023.01	07/18/2022 11:48:16 AM Central Daylight Time					07/18/2022 11:51:30 AM Central Daylight Time	CARESOURCE OHIO, INC.	CareSource MyCare Ohio	www.caresource.com/MyCare/	CareSource MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H8452	001	0	2023	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	5	1		1				08/03/2022	2023.01	08/03/2022 09:06:59 AM Central Daylight Time	08/02/2022 11:08:03 AM Central Daylight Time	08/02/2022 10:52:46 AM Central Daylight Time			08/04/2022 02:26:49 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	2023	New York (partial)		2		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						08/01/2022	2023.01	08/01/2022 03:56:59 PM Eastern Daylight Time	08/03/2022 04:46:57 PM Pacific Daylight Time	07/30/2022 07:39:44 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare No Premium Open (PPO)	01	04		1			H8458	001	0	2023	Select counties in NV		2		2			2									www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8458	002	0	1	04	01	H8458_002_0	3	1				0	0	05/29/2022	2023.01	05/29/2022 02:58:36 PM Eastern Daylight Time	06/03/2022 04:40:49 PM Pacific Daylight Time				07/15/2022 01:30:08 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Patriot Giveback Open (PPO)	01	04		1			H8458	002	0	2023	Select counties in NV		2		2			2									www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8458	003	0	1	04	01	H8458_003_0	4	1						08/01/2022	2023.01	08/01/2022 04:03:20 PM Eastern Daylight Time	08/03/2022 04:48:09 PM Pacific Daylight Time	07/30/2022 07:40:15 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare No Premium Open (PPO)	01	04		1			H8458	003	0	2023	Select counties in NV		2		2			2									www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(833)854-4766		(833)854-4766		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8492	001	0	1	01	01	H8492_001_0	6	1		1				08/05/2022	2023.01	08/05/2022 12:17:45 AM Central Daylight Time	08/04/2022 11:33:34 AM Central Daylight Time	08/04/2022 12:12:56 PM Central Daylight Time			08/05/2022 12:18:32 AM Central Daylight Time	DIGNITY CARE CORPORATION	Dignity Health Plan	www.dignityhealthplan.com	Dignity Health Plan (HMO I-SNP)	01	01		1			H8492	001	0	2023	Select Parishes in Louisiana		2		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		(866)266-6010		(225)964-8581		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8547	001	0	1	01	01	H8547_001_0	7	1						08/03/2022	2023.01	08/03/2022 12:31:05 PM Central Daylight Time	08/05/2022 02:28:38 PM Central Daylight Time	08/03/2022 06:38:10 PM Central Daylight Time			08/05/2022 07:10:46 PM Central Daylight Time	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Blue Cross and Blue Shield of Illinois	getblueil.com/mapd	Blue Medicare Advocate Health (HMO)	01	01		1			H8547	001	0	2023	Chicago Metro Area		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8552	020	0	1	04	01	H8552_020_0	6	1			2			05/18/2022	2023.01	05/18/2022 04:51:06 PM Pacific Daylight Time	08/04/2022 03:16:27 PM Pacific Daylight Time	08/04/2022 03:29:26 PM Pacific Daylight Time			08/04/2022 07:03:00 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem MediBlue Access (PPO)	01	04		1			H8552	020	0	2023	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	6	1		1	2			07/14/2022	2023.01	07/14/2022 01:33:43 PM Pacific Daylight Time		08/04/2022 03:36:57 PM Pacific Daylight Time		08/04/2022 03:20:23 PM Pacific Daylight Time	08/19/2022 08:29:30 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 ESRD Care (PPO C-SNP)	01	04		1			H8552	028	0	2023	Select Counties in California		2		2			1	4			00000000100000000000000					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	5	1			2			08/01/2022	2023.01	08/01/2022 01:39:59 PM Pacific Daylight Time	08/04/2022 03:16:28 PM Pacific Daylight Time	08/04/2022 03:29:29 PM Pacific Daylight Time			08/04/2022 07:03:00 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem MediBlue Access (PPO)	01	04		1			H8552	029	0	2023	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	8	1	2	1	1		0	08/01/2022	2023.01	08/01/2022 07:27:27 PM Eastern Daylight Time	08/15/2022 10:45:24 AM Eastern Daylight Time	08/11/2022 05:27:03 PM Eastern Daylight Time			08/17/2022 02:39:38 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	2023	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	2	1						05/23/2022	2023.01	05/23/2022 03:14:19 PM Pacific Daylight Time					06/03/2022 10:41:22 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	2023	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;15;16b;18a;	2		1									
H8552	802	0	1	04	01	H8552_802_0	2	1				0	0	05/23/2022	2023.01	05/23/2022 03:14:26 PM Pacific Daylight Time					06/03/2022 10:41:22 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	2023	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;15;16b;18a;	2		1									
H8553	001	0	1	04	01	H8553_001_0	4	1						08/03/2022	2023.01	08/03/2022 02:39:00 PM Eastern Daylight Time	08/03/2022 04:49:22 PM Pacific Daylight Time	07/30/2022 07:40:46 AM Pacific Daylight Time			08/04/2022 02:34:46 PM Pacific 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	2023	Select counties in AZ		2		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	05/29/2022	2023.01	05/29/2022 03:03:29 PM Eastern Daylight Time	06/03/2022 04:43:42 PM Pacific Daylight Time				07/15/2022 01:30:08 PM Pacific 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	2023	Select counties in AZ		2		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			
H8554	001	0	1	01	01	H8554_001_0	7	1						08/04/2022	2023.01	08/04/2022 02:24:39 PM Central Daylight Time	08/05/2022 02:30:03 PM Central Daylight Time	08/03/2022 06:39:30 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H8554	001	0	2023	San Antonio		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8554	003	0	1	01	01	H8554_003_0	6	1	2	1			0	07/12/2022	2023.01	07/12/2022 12:26:12 PM Central Daylight Time	06/05/2022 10:00:18 AM Central Daylight Time	06/04/2022 09:56:07 PM Central Daylight Time			07/13/2022 03:42:00 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)	01	01		1			H8554	003	0	2023	Oklahoma		2		2			1	3		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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8554	004	0	1	01	01	H8554_004_0	7	1						08/04/2022	2023.01	08/04/2022 02:26:45 PM Central Daylight Time	08/05/2022 02:32:56 PM Central Daylight Time	08/03/2022 06:42:08 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	getbluetx.com/mapd	Blue Cross Medicare Advantage Saver (HMO)	01	01		1			H8554	004	0	2023	San Antonio and El Paso		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	001	0	1	01	01	H8578_001_0	3	1					1	06/07/2022	2023.01	06/07/2022 12:18:53 PM Eastern Daylight Time	08/05/2022 02:26:58 PM Eastern Daylight Time	08/05/2022 02:34:37 PM Eastern Daylight Time			08/05/2022 02:41:05 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	2023	Hampden, Hampshire, Franklin, Berkshire Counties		2		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	2	1				0	0	06/01/2022	2023.01	06/01/2022 02:19:03 PM Eastern Daylight Time	06/03/2022 08:53:08 AM Eastern Daylight Time				06/06/2022 10:28:40 AM 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	2023	Hampden, Hampshire, Franklin, Berkshire Counties		2		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	3	1					1	08/04/2022	2023.01	08/04/2022 06:01:15 PM Eastern Daylight Time	08/05/2022 02:26:59 PM Eastern Daylight Time	08/05/2022 02:34:37 PM Eastern Daylight Time			08/05/2022 02:41:05 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	2023	Hampden, Hampshire, Franklin, Berkshire Counties		2		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	2	1				0	0	06/01/2022	2023.01	06/01/2022 02:45:44 PM Eastern Daylight Time	06/03/2022 08:58:04 AM Eastern Daylight Time				06/06/2022 10:28:40 AM 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	2023	Hampden, Hampshire, Franklin, Berkshire Counties		2		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	3	1					1	08/04/2022	2023.01	08/04/2022 06:01:43 PM Eastern Daylight Time	08/05/2022 02:26:59 PM Eastern Daylight Time	08/05/2022 02:34:37 PM Eastern Daylight Time			08/05/2022 02:41:05 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	2023	Hampden, Hampshire, Franklin, Berkshire Counties		2		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	3	1					1	08/04/2022	2023.01	08/04/2022 06:02:42 PM Eastern Daylight Time	08/05/2022 02:26:59 PM Eastern Daylight Time	08/05/2022 02:34:37 PM Eastern Daylight Time			08/05/2022 02:41:05 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	2023	Hampden, Hampshire, Franklin, Berkshire Counties		2		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	018	0	1	01	01	H8578_018_0	3	1					1	08/04/2022	2023.01	08/04/2022 06:03:42 PM Eastern Daylight Time	08/05/2022 02:26:59 PM Eastern Daylight Time	08/05/2022 02:34:37 PM Eastern Daylight Time			08/05/2022 02:41:05 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Baystate Health Preferred (HMO)	01	01		1			H8578	018	0	2023	Hampden, Hampshire		2		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	2	1						06/06/2022	2023.01	06/06/2022 01:11:56 PM Eastern Daylight Time					06/06/2022 01:27:15 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	2023	United States		1	4291	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		2				
H8578	802	0	1	02	01	H8578_802_0	2	1				0	0	06/06/2022	2023.01	06/06/2022 12:21:57 PM Eastern Daylight Time					06/06/2022 01:27:15 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	2023	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		2				
H8578	803	0	1	02	01	H8578_803_0	2	1						06/06/2022	2023.01	06/06/2022 12:21:49 PM Eastern Daylight Time					06/06/2022 01:27:15 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	2023	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	1	2;5;6;7c;7i;8b1;8b2;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		2				
H8597	001	0	1	01	01	H8597_001_0	3	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 09:45:04 AM Central Daylight Time	08/03/2022 10:32:29 AM Central Daylight Time	07/31/2022 11:51:24 PM Central Daylight Time			08/04/2022 04:14:12 PM Central 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 11:04:13 AM Central Daylight Time	08/03/2022 10:33:57 AM Central Daylight Time	07/31/2022 11:51:50 PM Central Daylight Time			08/04/2022 04:14:12 PM Central 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	2023	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	2	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 11:04:56 AM Central Daylight Time	08/03/2022 10:35:15 AM Central Daylight Time	07/31/2022 11:52:18 PM Central Daylight Time			08/04/2022 04:14:12 PM Central 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	2023	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	6	1						06/30/2022	2023.01	06/30/2022 10:15:52 AM Eastern Daylight Time	08/05/2022 05:23:20 PM Eastern Daylight Time	07/30/2022 12:28:16 PM Eastern Daylight Time			08/05/2022 05:28:15 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	2023	East Central OH		2		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	6	1						06/30/2022	2023.01	06/30/2022 10:16:10 AM Eastern Daylight Time	08/05/2022 05:23:20 PM Eastern Daylight Time	07/30/2022 12:29:46 PM Eastern Daylight Time			08/05/2022 05:28:15 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	2023	Southeastern OH, West Virginia		2		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	6	1						06/30/2022	2023.01	06/30/2022 10:16:28 AM Eastern Daylight Time	08/05/2022 05:23:20 PM Eastern Daylight Time	07/30/2022 12:31:16 PM Eastern Daylight Time			08/05/2022 05:28:15 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	2023	Kanawha and Surrounding Counties		2		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	2	1						06/06/2022	2023.01	06/06/2022 04:35:26 PM Eastern Daylight Time					06/06/2022 04:38:42 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	2023	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			
H8614	001	0	1	20	08	H8614_001_0	1	1						06/06/2022	2023.01	06/06/2022 11:33:09 AM Eastern Daylight Time		06/06/2022 11:34:46 AM Eastern Daylight Time			06/06/2022 11:36:19 AM Eastern Daylight Time	MILFORD WELLNESS VILLAGE PACE	Milford Wellness Village PACE	www.paceyourlifemwv.com	PACE Your LIFE - Dual Eligible (PACE)	08	20		1			H8614	001	0	2023	Kent Sussex Partial		2		2			2									www.milfordwellnessvillage.com	www.milfordwellnessvillage.com												(302)865-3565		(833)722-3302		(302)865-3565												(833)722-3302				(711)-																
H8614	002	0	1	20	08	H8614_002_0	1	1						06/06/2022	2023.01	06/06/2022 11:33:43 AM Eastern Daylight Time		06/06/2022 11:34:46 AM Eastern Daylight Time			06/06/2022 11:36:19 AM Eastern Daylight Time	MILFORD WELLNESS VILLAGE PACE	Milford Wellness Village PACE	www.paceyourlifemwv.com	PACE Your LIFE - Medicare Only (PACE)	08	20		1			H8614	002	0	2023	Kent Sussex Partial		2		2			2									www.milfordwellnessvillage.com	www.milfordwellnessvillage.com												(302)865-3565		(833)722-3302		(302)865-3565												(833)722-3302				(711)-																
H8634	002	0	1	04	01	H8634_002_0	7	1						07/05/2022	2023.01	07/05/2022 12:03:08 PM Central Daylight Time	08/05/2022 02:19:15 PM Central Daylight Time	08/03/2022 06:43:31 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getbluenm.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	002	0	2023	Bernalillo, Sandoval, Torrance and Valencia cntys		2		2			2									getbluenm.com/mapd/pharmacies	getbluenm.com/mapd/druglist	getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	003	0	1	04	01	H8634_003_0	6	1						08/04/2022	2023.01	08/04/2022 02:13:49 PM Central Daylight Time	08/05/2022 02:22:56 PM Central Daylight Time	08/03/2022 06:44:55 PM Central Daylight Time			08/05/2022 08:21:20 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	003	0	2023	Chicago Metro Area		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	004	0	1	04	01	H8634_004_0	6	1						07/05/2022	2023.01	07/05/2022 11:49:17 AM Central Daylight Time	08/05/2022 02:24:58 PM Central Daylight Time	08/03/2022 06:46:16 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H8634	004	0	2023	Chicago Metro Area		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	007	0	1	04	01	H8634_007_0	6	1						08/04/2022	2023.01	08/04/2022 02:15:15 PM Central Daylight Time	08/05/2022 02:27:06 PM Central Daylight Time	08/03/2022 06:47:38 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	007	0	2023	Springfield and Central Illinois		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	008	0	1	04	01	H8634_008_0	6	1						08/05/2022	2023.01	08/05/2022 02:31:46 PM Central Daylight Time	08/05/2022 02:29:07 PM Central Daylight Time	08/03/2022 06:48:59 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	008	0	2023	Chicago Metro Area		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	009	0	1	04	01	H8634_009_0	7	1	2	1			0	07/05/2022	2023.01	07/05/2022 04:12:20 PM Central Daylight Time	06/22/2022 01:22:12 PM Central Daylight Time	06/04/2022 09:58:56 PM Central Daylight Time			07/13/2022 02:06:55 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getbluenm.com/dsnp	Blue Cross MA Dual Care Plus Preferred (PPO D-SNP)	01	04		1			H8634	009	0	2023	New Mexico		2		2			1	3		2					2	getbluenm.com/dsnp/pharmacies	getbluenm.com/dsnp/druglist	getbluenm.com/dsnp/providers	(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(877)688-1813		(877)688-1813		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	010	0	1	04	01	H8634_010_0	7	1						08/03/2022	2023.01	08/03/2022 03:11:49 PM Central Daylight Time	08/05/2022 02:33:12 PM Central Daylight Time	08/03/2022 06:51:36 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getbluenm.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	010	0	2023	Bernalillo and Surrounding Counties		2		2			2									getbluetx.com/mapd/pharmacies	getbluenm.com/mapd/druglist	getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	011	0	1	04	01	H8634_011_0	6	1						08/03/2022	2023.01	08/03/2022 09:30:36 AM Central Daylight Time	08/05/2022 02:35:15 PM Central Daylight Time	08/03/2022 06:52:57 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	011	0	2023	East St. Louis & Surrounding Counties		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	012	0	1	04	01	H8634_012_0	6	1						08/03/2022	2023.01	08/03/2022 10:13:20 AM Central Daylight Time	08/05/2022 02:37:27 PM Central Daylight Time	08/03/2022 06:54:17 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	012	0	2023	Rockford, Rock Island, and Quincy Metro Markets		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	013	0	1	04	01	H8634_013_0	6	1						08/03/2022	2023.01	08/03/2022 10:16:28 AM Central Daylight Time	08/05/2022 02:39:27 PM Central Daylight Time	08/03/2022 06:55:38 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	013	0	2023	Peoria Metro Market & Williamson County		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	014	0	1	04	01	H8634_014_0	5	1						06/06/2022	2023.01	06/06/2022 12:40:52 PM Central Daylight Time	08/05/2022 02:42:41 PM Central Daylight Time	08/03/2022 06:56:57 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H8634	014	0	2023	Illinois		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	015	0	1	04	01	H8634_015_0	6	1						06/05/2022	2023.01	06/05/2022 06:46:30 PM Central Daylight Time	08/05/2022 02:44:45 PM Central Daylight Time	08/03/2022 06:58:18 PM Central Daylight Time			08/05/2022 07:14:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getbluenm.com/mapd	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H8634	015	0	2023	New Mexico		2		2			2									getbluenm.com/mapd/pharmacies	getbluenm.com/mapd/druglist	getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	016	0	1	04	01	H8634_016_0	6	1						08/05/2022	2023.01	08/05/2022 02:32:33 PM Central Daylight Time	08/05/2022 02:46:40 PM Central Daylight Time	08/03/2022 06:59:39 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Elite (PPO)	01	04		1			H8634	016	0	2023	DuPage & Will Counties		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	017	0	1	04	01	H8634_017_0	6	1						08/05/2022	2023.01	08/05/2022 02:32:57 PM Central Daylight Time	08/05/2022 02:48:57 PM Central Daylight Time	08/03/2022 07:01:06 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd/pharmacies	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	017	0	2023	Southern Illinois Counties		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	018	0	1	04	01	H8634_018_0	6	1						08/05/2022	2023.01	08/05/2022 02:33:37 PM Central Daylight Time	08/05/2022 02:52:09 PM Central Daylight Time	08/03/2022 07:02:29 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Health Choice (PPO)	01	04		1			H8634	018	0	2023	Illinois		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	019	0	1	04	01	H8634_019_0	5	1				0	0	07/05/2022	2023.01	07/05/2022 11:55:19 AM Central Daylight Time	06/05/2022 10:43:25 AM Central Daylight Time				07/13/2022 04:16:28 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Protect (PPO)	01	04		1			H8634	019	0	2023	Illinois		2		2			2									getblueil.com/mapd/pharmacies	www.myprime.com	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8634	020	0	1	04	01	H8634_020_0	6	1						08/05/2022	2023.01	08/05/2022 02:34:47 PM Central Daylight Time	08/05/2022 02:57:38 PM Central Daylight Time	08/03/2022 07:03:49 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Saver Plus (PPO)	01	04		1			H8634	020	0	2023	Rockford, Springfield, and East St. Louis Markets		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	021	0	1	04	01	H8634_021_0	6	1						08/05/2022	2023.01	08/05/2022 02:35:19 PM Central Daylight Time	08/05/2022 03:00:51 PM Central Daylight Time	08/03/2022 07:05:08 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	getblueil.com/mapd	Blue Cross Medicare Advantage Dental Premier (PPO)	01	04		1			H8634	021	0	2023	Illinois		2		2			2									getblueil.com/mapd/pharmacies	getblueil.com/mapd/druglist	getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	801	0	1	04	01	H8634_801_0	3	1						06/02/2022	2023.01	06/02/2022 08:50:47 AM Central Daylight Time					06/06/2022 08:35:13 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	801	0	2023	Nationwide		1	1146	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	803	0	1	04	01	H8634_803_0	3	1						06/02/2022	2023.01	06/02/2022 08:49:28 AM Central Daylight Time					06/06/2022 08:35:13 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	803	0	2023	Nationwide		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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	805	0	1	04	01	H8634_805_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 08:49:11 AM Central Daylight Time					06/06/2022 08:35:13 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	805	0	2023	Nationwide		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			
H8634	807	0	1	04	01	H8634_807_0	3	1						06/02/2022	2023.01	06/02/2022 08:48:51 AM Central Daylight Time					06/06/2022 08:35:13 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	807	0	2023	State of Oklahoma		1	1208	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	809	0	1	04	01	H8634_809_0	3	1						06/02/2022	2023.01	06/02/2022 08:47:40 AM Central Daylight Time					06/06/2022 08:35:13 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	809	0	2023	State of Oklahoma		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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	811	0	1	04	01	H8634_811_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 08:47:28 AM Central Daylight Time					06/06/2022 08:35:13 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	811	0	2023	State of Oklahoma		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			
H8634	813	0	1	04	01	H8634_813_0	3	1						06/02/2022	2023.01	06/02/2022 08:47:09 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	Nationwide		1	31533	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	815	0	1	04	01	H8634_815_0	3	1						06/02/2022	2023.01	06/02/2022 08:46:43 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	Nationwide		1	42007	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	817	0	1	04	01	H8634_817_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 08:46:21 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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			
H8634	819	0	1	04	01	H8634_819_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 08:46:06 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage (PPO)	01	04		1			H8634	819	0	2023	IL		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			
H8634	820	0	1	04	01	H8634_820_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 08:45:50 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage (PPO)	01	04		1			H8634	820	0	2023	IL		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			
H8634	821	0	1	04	01	H8634_821_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 08:45:32 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage (PPO)	01	04		1			H8634	821	0	2023	IL		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			
H8634	822	0	1	04	01	H8634_822_0	3	1						06/02/2022	2023.01	06/02/2022 08:45:07 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage (PPO)	01	04		1			H8634	822	0	2023	IL		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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	823	0	1	04	01	H8634_823_0	3	1						06/02/2022	2023.01	06/02/2022 08:44:49 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage (PPO)	01	04		1			H8634	823	0	2023	IL		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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	824	0	1	04	01	H8634_824_0	3	1						06/02/2022	2023.01	06/02/2022 08:44:28 AM Central Daylight Time					06/06/2022 08:35:13 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage (PPO)	01	04		1			H8634	824	0	2023	IL		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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8649	003	0	1	02	01	H8649_003_0	5	1			2			08/10/2022	2023.01	08/10/2022 03:08:44 PM Eastern Daylight Time	08/02/2022 02:59:09 PM Eastern Daylight Time	08/01/2022 12:52:44 AM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	2	1			2			05/31/2022	2023.01	05/31/2022 03:19:27 PM Eastern Daylight Time	08/02/2022 03:00:13 PM Eastern Daylight Time	08/01/2022 12:53:10 AM Eastern Daylight Time			08/04/2022 06:35:18 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	2023	Northern Utah Rural and Southwest Wyoming		2		2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(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	010	0	1	01	01	H8649_010_0	3	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 07:36:19 PM Eastern Daylight Time	08/02/2022 03:01:18 PM Eastern Daylight Time	08/01/2022 12:53:38 AM Eastern Daylight Time			08/04/2022 06:35:18 PM Eastern Daylight Time	AETNA HEALTH OF UTAH INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H8649	010	0	2023	Davis, Salt Lake, Utah and Weber 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			
H8649	801	0	1	01	01	H8649_801_0	1	1						05/31/2022	2023.01	05/31/2022 09:33:28 AM Eastern Daylight Time					06/02/2022 03:44:06 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	2023	Utah		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H8649	803	0	1	01	01	H8649_803_0	1	1				0	0	05/31/2022	2023.01	05/31/2022 11:14:43 AM Eastern Daylight Time					06/02/2022 03:44:06 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	2023	Utah		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;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				
H8655	004	0	1	20	08	H8655_004_0	1	1						06/02/2022	2023.01	06/02/2022 10:08:39 AM Mountain Daylight Time		05/27/2022 03:26:16 PM Mountain Daylight Time			06/02/2022 10:09:23 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	2023	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						06/02/2022	2023.01	06/02/2022 10:08:51 AM Mountain Daylight Time		05/27/2022 03:32:46 PM Mountain Daylight Time			06/02/2022 10:09:23 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	2023	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																
H8711	004	0	1	04	01	H8711_004_0	4	1						08/03/2022	2023.01	08/03/2022 02:59:52 PM Eastern Daylight Time	08/03/2022 08:26:51 PM Eastern Daylight Time	07/30/2022 10:41:18 AM Eastern Daylight Time			08/04/2022 05:27:00 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced Open (PPO)	01	04		1			H8711	004	0	2023	Select Counties in New Jersey		2		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	2	1					1	08/02/2022	2023.01	08/02/2022 01:17:51 PM Central Daylight Time	08/03/2022 10:57:54 AM Central Daylight Time	07/31/2022 03:50:47 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H8748	002	0	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 11:56:21 AM Central Daylight Time	08/03/2022 10:58:25 AM Central Daylight Time	07/31/2022 03:51:11 AM Central Daylight Time			08/04/2022 04:34:56 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus Plan 1 (HMO-POS)	01	02		1			H8748	008	0	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 11:44:47 AM Central Daylight Time	08/03/2022 10:58:57 AM Central Daylight Time	07/31/2022 03:51:36 AM Central Daylight Time			08/04/2022 04:34:56 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus Plan 2 (HMO-POS)	01	02		1			H8748	009	0	2023	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	1	1				0	0	05/31/2022	2023.01	05/31/2022 11:15:06 AM Central Daylight Time	06/01/2022 11:38:59 AM Central Daylight Time				06/02/2022 01:52:00 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H8748	019	0	2023	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	2	1					1	08/02/2022	2023.01	08/02/2022 01:22:03 PM Central Daylight Time	08/03/2022 10:59:29 AM Central Daylight Time	07/31/2022 03:52:01 AM Central Daylight Time			08/04/2022 03:25:02 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H8748	025	0	2023	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	026	0	1	02	01	H8748_026_0	2	1					1	08/03/2022	2023.01	08/03/2022 12:57:41 PM Central Daylight Time	08/03/2022 11:00:00 AM Central Daylight Time	07/31/2022 03:52:26 AM Central Daylight Time			08/04/2022 04:34:56 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Medicare Advantage Walmart Flex (HMO-POS)	01	02		1			H8748	026	0	2023	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			
H8764	001	0	1	01	01	H8764_001_0	7	1						08/04/2022	2023.01	08/04/2022 11:38:10 AM Pacific Daylight Time	08/05/2022 12:52:39 PM Pacific Daylight Time	08/05/2022 12:52:22 PM Pacific Daylight Time			08/05/2022 01:54:18 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health	www.aspirehealthplan.org	Aspire Health Advantage (HMO)	01	01		1			H8764	001	0	2023	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	8	1						08/04/2022	2023.01	08/04/2022 11:40:54 AM Pacific Daylight Time	08/05/2022 12:52:26 PM Pacific Daylight Time	08/05/2022 12:52:29 PM Pacific Daylight Time			08/05/2022 01:54:18 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health	www.aspirehealthplan.org	Aspire Health Plus (HMO-POS)	01	02		1			H8764	002	0	2023	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	9	1						08/04/2022	2023.01	08/04/2022 11:28:54 AM Pacific Daylight Time	08/09/2022 02:54:56 PM Pacific Daylight Time	08/05/2022 12:52:36 PM Pacific Daylight Time			08/09/2022 03:23:13 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health	www.aspirehealthplan.org	Aspire Health Value (HMO)	01	01		1			H8764	003	0	2023	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						05/27/2022	2023.01	05/27/2022 03:28:20 PM Pacific Daylight Time					06/06/2022 01:39:32 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health	www.aspirehealthplan.org	Aspire Health Group Plus (HMO-POS)	01	02		1			H8764	801	0	2023	Monterey County		1	3480	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	2	1			2		1	06/02/2022	2023.01	06/02/2022 03:52:26 PM Central Daylight Time	08/03/2022 11:39:49 AM Central Daylight Time	07/31/2022 03:52:50 AM Central Daylight Time			08/04/2022 02:59:25 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	2023	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	2	1			1		1	06/02/2022	2023.01	06/02/2022 03:22:39 PM Central Daylight Time	08/03/2022 11:40:26 AM Central Daylight Time	07/31/2022 03:53:15 AM Central Daylight Time			08/04/2022 02:59:25 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	2023	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	007	0	1	04	01	H8768_007_0	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:07:11 PM Central Daylight Time	08/03/2022 11:41:03 AM Central Daylight Time	07/31/2022 03:53:40 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Flex (PPO)	01	04		1			H8768	007	0	2023	Central Ohio		2		2			2									www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	008	0	1	04	01	H8768_008_0	3	1			1		1	08/03/2022	2023.01	08/03/2022 05:21:34 PM Central Daylight Time	08/03/2022 11:41:40 AM Central Daylight Time	07/31/2022 03:54:04 AM Central Daylight Time			08/05/2022 11:15:56 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	008	0	2023	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	3	1			1		1	08/03/2022	2023.01	08/03/2022 08:16:33 PM Central Daylight Time	08/03/2022 11:42:18 AM Central Daylight Time	07/31/2022 03:54:29 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	2	1			1		1	08/03/2022	2023.01	08/03/2022 12:07:58 PM Central Daylight Time	08/03/2022 11:42:56 AM Central Daylight Time	07/31/2022 03:54:54 AM Central Daylight Time			08/04/2022 02:59:25 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	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:08:40 PM Central Daylight Time	08/04/2022 11:39:11 AM Central Daylight Time	07/31/2022 03:55:18 AM Central Daylight Time			08/04/2022 02:59:25 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	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:09:14 PM Central Daylight Time	08/03/2022 11:44:23 AM Central Daylight Time	07/31/2022 03:55:43 AM Central Daylight Time			08/04/2022 02:59:25 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	2023	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	08/03/2022	2023.01	08/03/2022 12:10:31 PM Central Daylight Time	08/03/2022 11:45:01 AM Central Daylight Time	07/31/2022 03:56:08 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	014	0	2023	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	2	1			2		1	08/03/2022	2023.01	08/03/2022 12:11:13 PM Central Daylight Time	08/03/2022 11:45:40 AM Central Daylight Time	07/31/2022 03:56:33 AM Central Daylight Time			08/04/2022 02:59:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	015	0	2023	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	3	1			1		1	08/03/2022	2023.01	08/03/2022 05:27:16 PM Central Daylight Time	08/03/2022 11:46:18 AM Central Daylight Time	07/31/2022 03:56:58 AM Central Daylight Time			08/05/2022 11:15:56 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	016	0	2023	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	4	1			2		1	08/05/2022	2023.01	08/05/2022 11:30:40 AM Central Daylight Time	08/03/2022 11:46:56 AM Central Daylight Time	07/31/2022 03:57:22 AM Central Daylight Time			08/05/2022 11:55:43 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	2023	Select Counties in IA and IL	Des Moines Metro 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						2			
H8768	017	2	1	04	01	H8768_017_2	4	1			2		1	08/05/2022	2023.01	08/05/2022 11:30:47 AM Central Daylight Time	08/03/2022 11:47:35 AM Central Daylight Time	07/31/2022 03:57:48 AM Central Daylight Time			08/05/2022 11:55:43 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	2023	Select Counties in IA and IL	Select Counties in Iowa and Illinois	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			
H8768	018	0	1	04	01	H8768_018_0	1	1			2	0	0	06/01/2022	2023.01	06/01/2022 08:42:56 AM Central Daylight Time	06/01/2022 10:57:44 AM Central Daylight Time				06/02/2022 12:49:37 PM 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	2023	Select Counties in Iowa and Illinois		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			
H8768	019	0	1	04	01	H8768_019_0	1	1			2	0	0	06/02/2022	2023.01	06/02/2022 03:34:41 PM Central Daylight Time	06/01/2022 10:58:30 AM Central Daylight Time				06/03/2022 10:37:20 AM 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	2023	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	1	1			2	0	0	06/02/2022	2023.01	06/02/2022 03:36:20 PM Central Daylight Time	06/01/2022 10:59:15 AM Central Daylight Time				06/03/2022 10:37:20 AM 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	2023	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	1	1			2	0	0	06/02/2022	2023.01	06/02/2022 03:38:09 PM Central Daylight Time	06/01/2022 11:00:02 AM Central Daylight Time				06/03/2022 10:37:20 AM 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	2023	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	2	1			2		1	08/04/2022	2023.01	08/04/2022 02:38:42 PM Central Daylight Time	08/03/2022 11:48:12 AM Central Daylight Time	07/31/2022 03:58:12 AM Central Daylight Time			08/04/2022 05:25:25 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	2023	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	08/03/2022	2023.01	08/03/2022 05:29:54 PM Central Daylight Time	08/03/2022 11:48:50 AM Central Daylight Time	07/31/2022 03:58:37 AM Central Daylight Time			08/05/2022 11:15:56 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	023	0	2023	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	08/03/2022	2023.01	08/03/2022 05:32:24 PM Central Daylight Time	08/03/2022 11:49:27 AM Central Daylight Time	07/31/2022 03:59:02 AM Central Daylight Time			08/05/2022 11:15:56 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	024	0	2023	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	1	1			2	0	0	06/02/2022	2023.01	06/02/2022 01:47:22 PM Central Daylight Time	06/01/2022 11:03:06 AM Central Daylight Time				06/02/2022 02:02:06 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	2023	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	08/03/2022	2023.01	08/03/2022 05:37:25 PM Central Daylight Time	08/03/2022 11:50:05 AM Central Daylight Time	07/31/2022 03:59:27 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	08/03/2022	2023.01	08/03/2022 05:40:02 PM Central Daylight Time	08/03/2022 11:50:44 AM Central Daylight Time	07/31/2022 03:59:51 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	1	1			1	0	0	06/02/2022	2023.01	06/02/2022 01:47:30 PM Central Daylight Time	06/01/2022 11:05:22 AM Central Daylight Time				06/02/2022 02:02:06 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	2023	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	030	0	1	04	01	H8768_030_0	4	1			2		1	08/03/2022	2023.01	08/03/2022 12:58:51 PM Central Daylight Time	08/03/2022 11:51:23 AM Central Daylight Time	07/31/2022 04:00:16 AM Central Daylight Time			08/04/2022 04:34:56 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	030	0	2023	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	07/15/2022	2023.01	07/15/2022 01:47:57 PM Central Daylight Time	06/01/2022 11:06:54 AM Central Daylight Time				07/18/2022 11:58:27 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	2023	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	4	1			2		1	08/05/2022	2023.01	08/05/2022 11:30:56 AM Central Daylight Time	08/03/2022 11:52:01 AM Central Daylight Time	07/31/2022 04:00:41 AM Central Daylight Time			08/05/2022 11:55:43 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	2023	Select Counties in Iowa and Illinois		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			
H8768	033	0	1	04	01	H8768_033_0	2	1			2		1	08/04/2022	2023.01	08/04/2022 10:23:40 AM Central Daylight Time	08/03/2022 11:52:40 AM Central Daylight Time	07/31/2022 04:01:06 AM Central Daylight Time			08/04/2022 02:59:25 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	2023	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			
H8768	034	0	1	04	01	H8768_034_0	3	1			2		1	08/03/2022	2023.01	08/03/2022 12:59:29 PM Central Daylight Time	08/03/2022 11:53:19 AM Central Daylight Time	07/31/2022 04:01:30 AM Central Daylight Time			08/04/2022 04:34:56 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	034	0	2023	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		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	035	0	1	04	01	H8768_035_0	2	1			2		1	08/04/2022	2023.01	08/04/2022 02:38:52 PM Central Daylight Time	08/03/2022 11:53:58 AM Central Daylight Time	07/31/2022 04:01:55 AM Central Daylight Time			08/04/2022 05:25:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice Premier (PPO)	01	04		1			H8768	035	0	2023	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			
H8769	001	0	1	20	08	H8769_001_0	1	1						06/01/2022	2023.01	06/01/2022 12:23:19 PM Central Daylight Time		05/27/2022 10:16:33 AM Central Daylight Time			06/01/2022 12:24:48 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	2023	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	1	1						06/01/2022	2023.01	06/01/2022 12:23:31 PM Central Daylight Time		05/27/2022 10:16:41 AM Central Daylight Time			06/01/2022 12:24:48 PM Central Daylight Time	Center for Gerontology	Ascension Living PACE of Michigan	https://ascension.org/GenesysPACE	Ascension Living PACE  Michigan (PACE)	08	20		1			H8769	002	0	2023	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						06/01/2022	2023.01	06/01/2022 01:23:15 PM Eastern Daylight Time		05/26/2022 02:07:57 PM Eastern Daylight Time			06/01/2022 01:26:10 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	2023	Niagara, NY		2		2			2									Pharmastar	Pharmastar										(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220									(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220															
H8777	002	0	1	20	08	H8777_002_0	1	1						06/01/2022	2023.01	06/01/2022 01:11:18 PM Eastern Daylight Time		05/26/2022 02:08:38 PM Eastern Daylight Time			06/01/2022 01:26:10 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	2023	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	9	1					1	09/27/2022	2023.01	09/27/2022 03:12:45 PM Central Daylight Time	08/03/2022 11:28:29 AM Central Daylight Time	08/01/2022 08:01:20 PM Central Daylight Time			09/28/2022 07:55:46 AM Central Daylight Time	UCARE HEALTH, INC.	UCare	https://home.ucare.org	EssentiaCare Secure (PPO)	01	04		1			H8783	001	0	2023	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	12	1					1	09/27/2022	2023.01	09/27/2022 03:11:51 PM Central Daylight Time	08/03/2022 11:30:38 AM Central Daylight Time	08/01/2022 08:14:34 PM Central Daylight Time			09/28/2022 07:55:46 AM Central Daylight Time	UCARE HEALTH, INC.	UCare	https://home.ucare.org	EssentiaCare Grand (PPO)	01	04		1			H8783	002	0	2023	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	10	1					1	09/14/2022	2023.01	09/14/2022 02:08:29 PM Central Daylight Time	08/08/2022 03:05:30 PM Central Daylight Time	08/01/2022 08:26:55 PM Central Daylight Time			09/15/2022 02:07:40 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	https://home.ucare.org	EssentiaCare Access (PPO)	01	04		1			H8783	003	0	2023	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						09/07/2022	2023.01	09/07/2022 11:59:21 AM Eastern Daylight Time					09/07/2022 12:08:03 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	2023	Select TX Service Areas		2	123734	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	4	1		1			0	07/12/2022	2023.01	07/12/2022 11:20:26 AM Eastern Daylight Time	08/05/2022 07:53:31 AM Mountain Daylight Time	08/05/2022 05:21:28 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	PERENNIAL ADVANTAGE OF OHIO, INC.	Perennial Advantage	www.perennialadvantage.com	Perennial Advantage Strive (HMO I-SNP)	01	01		1			H8797	001	0	2023	Ohio (partial)		2		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	4	1		1			1	08/04/2022	2023.01	08/04/2022 09:43:44 PM Eastern Daylight Time	08/05/2022 07:53:58 AM Mountain Daylight Time	08/05/2022 05:21:46 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	PERENNIAL ADVANTAGE OF OHIO, INC.	Perennial Advantage	www.perennialadvantage.com	Perennial Advantage Concierge (HMO C-SNP)	01	01		1			H8797	002	0	2023	Ohio (partial)		2		2			1	4			00000000000000000010000					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	003	0	1	01	01	H8797_003_0	4	1					0	08/04/2022	2023.01	08/04/2022 09:44:34 PM Eastern Daylight Time	08/05/2022 07:54:25 AM Mountain Daylight Time	08/05/2022 05:22:05 AM Mountain Daylight Time			08/05/2022 10:21:42 AM Mountain Daylight Time	PERENNIAL ADVANTAGE OF OHIO, INC.	Perennial Advantage	www.perennialadvantage.com	Perennial Advantage (HMO)	01	01		1			H8797	003	0	2023	Ohio (partial)		2		2			2									www.placeholder.com	www.placeholder.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						06/03/2022	2023.01	06/03/2022 02:08:57 PM Eastern Daylight Time		06/03/2022 02:42:42 PM Eastern Daylight Time			06/03/2022 02:45:23 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	2023	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						06/03/2022	2023.01	06/03/2022 02:09:25 PM Eastern Daylight Time		06/03/2022 02:42:41 PM Eastern Daylight Time			06/03/2022 02:45:23 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	2023	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	9	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:38:49 PM Pacific Daylight Time	08/04/2022 06:17:20 PM Pacific Daylight Time	08/01/2022 10:52:36 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF ARIZONA, INC.	Molina Healthcare of Arizona	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H8845	001	0	2023	Gila, Maricopa, Pinal		2		2			1	3		1					1	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)424-4509		(800)424-4509		(866)403-8293		(866)403-8293		(800)424-4509		(800)424-4509		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8845	002	0	1	01	01	H8845_002_0	7	1					1	08/04/2022	2023.01	08/04/2022 05:47:10 PM Pacific Daylight Time	08/04/2022 06:17:48 PM Pacific Daylight Time	08/01/2022 10:53:10 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF ARIZONA, INC.	Molina Healthcare of Arizona	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H8845	002	0	2023	Gila, Maricopa, Pinal		2		2			2									www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)424-4509		(800)424-4509		(866)403-8293		(866)403-8293		(800)424-4509		(800)424-4509		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8845	003	0	1	01	01	H8845_003_0	7	1					1	08/04/2022	2023.01	08/04/2022 01:32:21 PM Pacific Daylight Time	08/04/2022 06:18:16 PM Pacific Daylight Time	08/01/2022 03:34:38 PM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF ARIZONA, INC.	Molina Healthcare of Arizona	www.molinahealthcare.com/medicare	Molina Medicare Choice Care Select (HMO)	01	01		1			H8845	003	0	2023	Gila, Maricopa, Pinal		2		2			2									www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)424-4509		(800)424-4509		(866)403-8293		(866)403-8293		(800)424-4509		(800)424-4509		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	001	0	1	01	01	H8849_001_0	5	1		1	2		1	08/02/2022	2023.01	08/02/2022 12:55:09 AM Pacific Daylight Time	08/04/2022 03:20:24 PM Pacific Daylight Time	08/04/2022 03:37:00 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Tarrant County		2		2			1	4			00000010000000000000000					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)371-1080		(833)371-1080		(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	5	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:34:18 PM Pacific Daylight Time	08/04/2022 03:20:26 PM Pacific Daylight Time	08/04/2022 03:37:02 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	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)740-1110		(833)740-1110		(855)793-1926		(855)793-1926		(833)371-1080		(833)371-1080		(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	5	1		1	2		1	07/14/2022	2023.01	07/14/2022 01:34:27 PM Pacific Daylight Time	08/04/2022 03:20:27 PM Pacific Daylight Time	08/04/2022 03:37:05 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Harris County		2		2			1	4			00000010000000000000000					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)371-1080		(833)371-1080		(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	5	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:34:35 PM Pacific Daylight Time	08/04/2022 03:20:28 PM Pacific Daylight Time	08/04/2022 03:37:08 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Harris County		2		2			1	4			00000000000000010000000					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)371-1080		(833)371-1080		(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	5	1		1	2		0	07/14/2022	2023.01	07/14/2022 01:34:45 PM Pacific Daylight Time	08/04/2022 03:20:29 PM Pacific Daylight Time	08/04/2022 03:37:10 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Harris County		2		2			1	4			00000000000100000000000					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)371-1080		(833)371-1080		(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	5	1			2		0	08/02/2022	2023.01	08/02/2022 12:56:03 AM Pacific Daylight Time	08/04/2022 03:20:31 PM Pacific Daylight Time	08/04/2022 03:37:13 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Select Plus (HMO)	01	01		1			H8849	006	0	2023	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)371-1080		(833)371-1080		(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	6	1			2		0	08/01/2022	2023.01	08/01/2022 11:55:00 PM Pacific Daylight Time	08/04/2022 03:20:32 PM Pacific Daylight Time	08/04/2022 03:37:16 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	1	2023	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)371-1080		(833)371-1080		(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	6	1			2		0	08/02/2022	2023.01	08/02/2022 12:57:09 AM Pacific Daylight Time	08/04/2022 03:20:33 PM Pacific Daylight Time	08/04/2022 03:37:18 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	2	2023	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)371-1080		(833)371-1080		(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	6	1			2		0	07/14/2022	2023.01	07/14/2022 01:35:29 PM Pacific Daylight Time	08/04/2022 03:20:35 PM Pacific Daylight Time	08/04/2022 03:37:21 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	3	2023	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)371-1080		(833)371-1080		(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	6	1			2		0	08/02/2022	2023.01	08/02/2022 12:58:21 AM Pacific Daylight Time	08/04/2022 03:20:36 PM Pacific Daylight Time	08/04/2022 03:37:24 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	4	2023	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)371-1080		(833)371-1080		(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	7	1			2		0	08/02/2022	2023.01	08/02/2022 12:59:32 AM Pacific Daylight Time	08/04/2022 03:20:37 PM Pacific Daylight Time	08/04/2022 03:37:26 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	5	2023	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)371-1080		(833)371-1080		(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	6	1			2		0	07/14/2022	2023.01	07/14/2022 01:36:02 PM Pacific Daylight Time	08/04/2022 03:20:39 PM Pacific Daylight Time	08/04/2022 03:37:29 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	6	2023	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)371-1080		(833)371-1080		(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	6	1			2		0	08/02/2022	2023.01	08/02/2022 01:00:36 AM Pacific Daylight Time	08/04/2022 03:20:40 PM Pacific Daylight Time	08/04/2022 03:37:32 PM Pacific Daylight Time			08/04/2022 05:09:09 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Select Plus (HMO)	01	01		1			H8849	009	0	2023	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)371-1080		(833)371-1080		(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	05/31/2022	2023.01	05/31/2022 10:35:30 AM Eastern Daylight Time	08/04/2022 06:15:35 PM Eastern Daylight Time	08/04/2022 06:27:50 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:37:12 AM Eastern Daylight Time	08/04/2022 06:15:37 PM Eastern Daylight Time	08/04/2022 06:27:53 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:39:29 AM Eastern Daylight Time	08/04/2022 06:15:38 PM Eastern Daylight Time	08/04/2022 06:27:55 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:41:40 AM Eastern Daylight Time	08/04/2022 06:15:40 PM Eastern Daylight Time	08/04/2022 06:27:58 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 10:43:18 AM Eastern Daylight Time	08/04/2022 06:15:41 PM Eastern Daylight Time	08/04/2022 06:28:01 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:01:04 PM Eastern Daylight Time	08/04/2022 06:15:42 PM Eastern Daylight Time	08/04/2022 06:28:03 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:00:37 PM Eastern Daylight Time	08/04/2022 06:15:44 PM Eastern Daylight Time	08/04/2022 06:28:06 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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)371-1080		(833)371-1080		(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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:02:41 PM Eastern Daylight Time	08/04/2022 06:15:45 PM Eastern Daylight Time	08/04/2022 06:28:09 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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)371-1080		(833)371-1080		(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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:03:55 PM Eastern Daylight Time	08/04/2022 06:15:46 PM Eastern Daylight Time	08/04/2022 06:28:11 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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)371-1080		(833)371-1080		(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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:05:12 PM Eastern Daylight Time	08/04/2022 06:15:48 PM Eastern Daylight Time	08/04/2022 06:28:14 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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)371-1080		(833)371-1080		(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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:07:25 PM Eastern Daylight Time	08/04/2022 06:15:49 PM Eastern Daylight Time	08/04/2022 06:28:17 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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)371-1080		(833)371-1080		(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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:08:40 PM Eastern Daylight Time	08/04/2022 06:15:50 PM Eastern Daylight Time	08/04/2022 06:28:19 PM Eastern Daylight Time			08/04/2022 07:52:55 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	2023	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)371-1080		(833)371-1080		(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	5	1		1	2		0	08/02/2022	2023.01	08/02/2022 01:01:41 AM Pacific Daylight Time	08/04/2022 03:20:42 PM Pacific Daylight Time	08/04/2022 03:37:35 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Select Counties in TX		2		2			1	4			00000000000000010000000					https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(877)269-5660		(877)269-5660		(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	5	1		1	2		0	08/02/2022	2023.01	08/02/2022 01:02:46 AM Pacific Daylight Time	08/04/2022 03:20:43 PM Pacific Daylight Time	08/04/2022 03:37:37 PM Pacific Daylight Time			08/04/2022 05:09:09 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	2023	Select Counties in TX		2		2			1	4			00000000000100000000000					https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(877)269-5660		(877)269-5660		(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	11	1	2	1			0	08/10/2022	2023.01	08/10/2022 10:17:34 AM Eastern Daylight Time	08/05/2022 04:03:23 PM Eastern Daylight Time	08/05/2022 04:53:09 PM Eastern Daylight Time			08/10/2022 10:18:49 AM 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	2023	Maryland		2		2			1	3		2					1	carefirst.com/mddsnp	carefirst.com/mddsnp	carefirst.com/mddsnp	(844)386-6762		(410)779-9932		(844)262-1122		(844)262-1122		(844)786-6762		(410)779-9932		(844)262-1122		(844)262-1122		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8889	001	0	1	04	01	H8889_001_0	7	1					1	08/04/2022	2023.01	08/04/2022 01:40:06 PM Central Daylight Time	08/10/2022 03:02:17 PM Central Daylight Time	08/04/2022 02:04:41 PM Central Daylight Time			08/10/2022 03:37:14 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-001 (PPO)	01	04		1			H8889	001	0	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 10:03:48 AM Central Daylight Time	08/10/2022 03:02:28 PM Central Daylight Time	08/04/2022 02:04:52 PM Central Daylight Time			08/10/2022 03:37:14 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-002 (PPO)	01	04		1			H8889	002	0	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 01:40:53 PM Central Daylight Time	08/10/2022 03:01:48 PM Central Daylight Time	08/04/2022 02:05:05 PM Central Daylight Time			08/10/2022 03:37:14 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-003 (PPO)	01	04		1			H8889	003	0	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 10:05:30 AM Central Daylight Time	08/10/2022 03:01:57 PM Central Daylight Time	08/04/2022 02:05:16 PM Central Daylight Time			08/10/2022 03:37:14 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-004 (PPO)	01	04		1			H8889	004	0	2023	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	6	1					1	08/04/2022	2023.01	08/04/2022 10:06:00 AM Central Daylight Time	08/04/2022 02:08:48 PM Central Daylight Time	08/04/2022 02:05:24 PM Central Daylight Time			08/04/2022 03:21:14 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-005 (PPO)	01	04		1			H8889	005	0	2023	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	008	0	1	04	01	H8889_008_0	6	1					1	08/04/2022	2023.01	08/04/2022 10:06:48 AM Central Daylight Time	08/04/2022 02:08:58 PM Central Daylight Time	08/04/2022 02:05:31 PM Central Daylight Time			08/04/2022 03:21:14 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-008 (PPO)	01	04		1			H8889	008	0	2023	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	4	1				0	0	07/18/2022	2023.01	07/18/2022 11:26:32 AM Central Daylight Time	06/02/2022 08:53:14 AM Central Daylight Time				07/18/2022 01:40:15 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-009 (PPO)	01	04		1			H8889	009	0	2023	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						06/02/2022	2023.01	06/02/2022 12:20:21 PM Central Daylight Time					06/02/2022 03:35:03 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Group Advantage Solution (PPO)	01	04		1			H8889	801	0	2023	Select Counties in the US		1	60000	2			2									medica.com/Members	medica.com/Members	medica.com/Members	(800)575-2330		(952)992-2330		(855)844-6395		(952)992-2345		(800)575-2330		(952)992-2330		(855)844-6395		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7k;8a;8b1;8b2;9a1;9b;11a;11b;15;	2		1									
H8894	001	0	1	01	01	H8894_001_0	6	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 02:49:39 PM Pacific Daylight Time	08/04/2022 01:40:00 AM Pacific Daylight Time	08/04/2022 01:40:00 AM Pacific Daylight Time			08/04/2022 02:58:20 PM Pacific Daylight Time	Inland Empire Health Plan	IEHP DualChoice	www.iehp.org	IEHP DualChoice (HMO D-SNP)	01	01		1			H8894	001	0	2023	Riverside and San Bernardino Counties		2		2			1	3		1					1	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		2					1					2	2			
H8902	001	0	1	01	01	H8902_001_0	8	1					1	08/03/2022	2023.01	08/03/2022 03:40:43 PM Pacific Daylight Time	08/03/2022 08:10:59 PM Pacific Daylight Time	08/02/2022 10:09:00 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN TEXAS, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H8902	001	0	2023	Bexar County		2		2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8902	002	0	1	01	01	H8902_002_0	8	1		1			1	08/03/2022	2023.01	08/03/2022 03:41:08 PM Pacific Daylight Time	08/03/2022 08:11:32 PM Pacific Daylight Time	08/02/2022 10:09:13 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN TEXAS, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H8902	002	0	2023	Bexar County		2		2			1	4			00000010000000000000000					www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8902	003	0	1	01	01	H8902_003_0	8	1		1			1	08/03/2022	2023.01	08/03/2022 03:42:23 PM Pacific Daylight Time	08/03/2022 08:12:05 PM Pacific Daylight Time	08/02/2022 10:09:27 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN TEXAS, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H8902	003	0	2023	Bexar County		2		2			1	4			00000000000000010000000					www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8902	004	0	1	01	01	H8902_004_0	11	1					1	08/03/2022	2023.01	08/03/2022 03:41:59 PM Pacific Daylight Time	08/03/2022 08:12:39 PM Pacific Daylight Time	08/02/2022 10:09:41 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN TEXAS, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H8902	004	0	2023	Bexar County		2		2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8902	005	0	1	01	01	H8902_005_0	8	1					1	08/03/2022	2023.01	08/03/2022 03:43:38 PM Pacific Daylight Time	08/03/2022 08:13:13 PM Pacific Daylight Time	08/02/2022 10:09:45 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN TEXAS, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H8902	005	0	2023	Harris County		2		2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8902	006	0	1	01	01	H8902_006_0	8	1		1			1	08/03/2022	2023.01	08/03/2022 03:44:14 PM Pacific Daylight Time	08/03/2022 08:13:44 PM Pacific Daylight Time	08/02/2022 10:09:59 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN TEXAS, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H8902	006	0	2023	Harris County		2		2			1	4			00000010000000000000000					www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8902	007	0	1	01	01	H8902_007_0	8	1		1			1	08/03/2022	2023.01	08/03/2022 03:44:41 PM Pacific Daylight Time	08/03/2022 08:14:16 PM Pacific Daylight Time	08/02/2022 10:10:12 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN TEXAS, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H8902	007	0	2023	Harris County		2		2			1	4			00000000000000010000000					www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8902	008	0	1	01	01	H8902_008_0	11	1					1	08/03/2022	2023.01	08/03/2022 04:13:49 PM Pacific Daylight Time	08/03/2022 08:14:48 PM Pacific Daylight Time	08/02/2022 10:10:26 PM Pacific Daylight Time			08/04/2022 06:42:18 PM Pacific Daylight Time	SCAN HEALTH PLAN TEXAS, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H8902	008	0	2023	Harris County		2		2			2									www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(855)844-7226		(855)844-7226		(855)601-7223		(855)601-7223		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	001	0	1	02	01	H8908_001_0	4	1			1		1	05/30/2022	2023.01	05/30/2022 01:18:34 PM Eastern Daylight Time	08/03/2022 04:23:34 PM Eastern Daylight Time	07/30/2022 09:56:26 AM Eastern Daylight Time			08/04/2022 12:11:10 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H8908-001 (HMO-POS)	01	02		1			H8908	001	0	2023	Detroit Area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 03:41:37 PM Eastern Daylight Time	08/03/2022 04:30:14 PM Eastern Daylight Time	07/30/2022 09:56:52 AM Eastern Daylight Time			08/04/2022 12:11:10 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	2023	Grand Rapids area		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H8908_004_0	5	1			1		1	08/01/2022	2023.01	08/01/2022 03:41:54 PM Eastern Daylight Time	08/03/2022 04:36:52 PM Eastern Daylight Time	07/30/2022 09:57:16 AM Eastern Daylight Time			08/04/2022 12:11:10 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H8908-004 (HMO-POS)	01	02		1			H8908	004	0	2023	Southeast Michigan		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/29/2022	2023.01	05/29/2022 10:48:50 PM Eastern Daylight Time	08/03/2022 04:37:48 PM Eastern Daylight Time	07/30/2022 09:57:44 AM Eastern Daylight Time			08/04/2022 12:11:10 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	2023	Select counties in Michigan		2		2			1	3		1					1	https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/27/2022	2023.01	05/27/2022 06:20:01 PM Eastern Daylight Time					05/27/2022 06:28:23 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	801	0	2023	Select Counties in Michigan		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 06:21:45 PM Eastern Daylight Time					05/27/2022 06:28:23 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	802	0	2023	Select Counties in Michigan		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/27/2022	2023.01	05/27/2022 06:25:31 PM Eastern Daylight Time					05/27/2022 06:28:23 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	804	0	2023	Select Counties in Michigan		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 06:28:00 PM Eastern Daylight Time					05/27/2022 06:28:23 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	805	0	2023	Select Counties in Michigan		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1	2	1			0	06/06/2022	2023.01	06/06/2022 11:32:31 AM Eastern Daylight Time	08/05/2022 12:31:45 PM Eastern Daylight Time	08/05/2022 12:31:18 PM Eastern Daylight Time			08/09/2022 03:20:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/navicare	NaviCare (HMO D-SNP)	01	01		1			H8928	001	0	2023	Massachusetts except Dukes and Nantucket counties		2		2			1	3		1					1	fallonhealth.org/pharmacyfinder	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	8	1						08/05/2022	2023.01	08/05/2022 07:18:11 AM	08/05/2022 02:20:09 PM	08/05/2022 02:20:09 PM			08/05/2022 02:22:21 PM	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Oscar	www.hioscar.com/medicare	Oscar + Holy Cross + Memorial (HMO)	01	01		1			H8961	001	0	2023	Broward County		2		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	8	1						08/05/2022	2023.01	08/05/2022 07:19:02 AM	08/05/2022 02:20:09 PM	08/05/2022 02:20:09 PM			08/05/2022 02:22:21 PM	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	2023	Broward county		2		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	8	1						08/05/2022	2023.01	08/05/2022 07:19:08 AM	08/05/2022 02:20:09 PM	08/05/2022 02:20:09 PM			08/05/2022 02:22:21 PM	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	2023	Broward county		2		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	6	1		1				08/02/2022	2023.01	08/02/2022 08:12:37 PM Central Daylight Time	08/03/2022 11:49:21 AM Central Daylight Time	08/02/2022 11:36:46 AM Central Daylight Time			08/04/2022 12:49:43 PM 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	2023	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		(855)800-8872		(855)800-8872		(844)637-4760		(844)637-4760		(888)279-1549		(888)279-1549		(888)279-1549		(888)279-1549		(711)-		(711)-		(888)279-1549		(888)279-1549		2					2					2	2			
H8967	002	0	1	01	01	H8967_002_0	6	1		1				08/02/2022	2023.01	08/02/2022 08:19:06 PM Central Daylight Time	08/03/2022 11:49:57 AM Central Daylight Time	08/02/2022 11:38:13 AM Central Daylight Time			08/04/2022 12:49:43 PM 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	2023	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		(855)800-8872		(855)800-8872		(844)637-4760		(844)637-4760		(888)279-1549		(888)279-1549		(888)279-1549		(888)279-1549		(711)-		(711)-		(888)279-1549		(888)279-1549		2					2					2	2			
H8998	001	0	1	04	01	H8998_001_0	4	1					0	08/04/2022	2023.01	08/04/2022 10:28:42 AM Eastern Daylight Time	08/04/2022 05:54:02 PM Eastern Daylight Time	08/04/2022 05:54:03 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Trinity Health Plan Of New England	www.medigold.com	Trinity Health Plan Of New England Choice (PPO)	01	04		1			H8998	001	0	2023	Select Counties in Connecticut		2		2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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			
H8998	801	0	1	04	01	H8998_801_0	2	1						05/26/2022	2023.01	05/26/2022 12:37:00 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Trinity Health Plan Of New England	www.medigold.com	Trinity Health Plan Of New England Choice EGWP 1 (PPO)	01	04		1			H8998	801	0	2023	Select Counties in Connecticut		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H8998	802	0	1	04	01	H8998_802_0	2	1						05/26/2022	2023.01	05/26/2022 12:44:24 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Trinity Health Plan Of New England	www.medigold.com	Trinity Health Plan Of New England Choice EGWP 2 (PPO)	01	04		1			H8998	802	0	2023	Select Counties in Connecticut		1	12	2			2									www.medigold.com/tools-and-resources/drug-benefits/	www.medigold.com/tools-and-resources/drug-benefits/formulary	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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H9001	030	15	1	01	01	H9001_030_15	8	1						07/12/2022	2023.01	07/12/2022 02:47:54 PM Eastern Daylight Time	08/05/2022 12:31:49 PM Eastern Daylight Time	08/05/2022 12:31:22 PM Eastern Daylight Time			08/05/2022 12:55:48 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	2023	Massachusetts except Dukes and Nantucket Counties	Worcester County	2		2			2									fallonhealth.org/pharmacyfinder	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	6	1						07/12/2022	2023.01	07/12/2022 02:48:59 PM Eastern Daylight Time	08/05/2022 12:31:55 PM Eastern Daylight Time	08/05/2022 12:31:27 PM Eastern Daylight Time			08/05/2022 12:55:48 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	2023	Massachusetts except Dukes and Nantucket Counties	Franklin, Hampden and Hampshire Counties	2		2			2									fallonhealth.org/pharmacyfinder	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	18	1	01	01	H9001_030_18	6	1						07/12/2022	2023.01	07/12/2022 02:48:59 PM Eastern Daylight Time	08/05/2022 12:32:00 PM Eastern Daylight Time	08/05/2022 12:31:31 PM Eastern Daylight Time			08/05/2022 12:55:48 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	01	01		1			H9001	030	18	2023	Massachusetts except Dukes and Nantucket Counties	BAR, BER, BRI, ESS, MID, NOR, PLY and SUF Counties	2		2			2									fallonhealth.org/pharmacyfinder	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	7	1						07/12/2022	2023.01	07/12/2022 02:48:07 PM Eastern Daylight Time	08/05/2022 12:32:05 PM Eastern Daylight Time	08/05/2022 12:31:35 PM Eastern Daylight Time			08/05/2022 12:55:48 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	2023	Massachusetts except Dukes and Nantucket Counties	Worcester County	2		2			2									fallonhealth.org/pharmacyfinder	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	6	1						07/12/2022	2023.01	07/12/2022 02:50:03 PM Eastern Daylight Time	08/05/2022 12:32:10 PM Eastern Daylight Time	08/05/2022 12:31:39 PM Eastern Daylight Time			08/05/2022 12:55:48 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	2023	Massachusetts except Dukes and Nantucket Counties	Franklin, Hampden and Hampshire Counties	2		2			2									fallonhealth.org/pharmacyfinder	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	18	1	01	01	H9001_031_18	6	1						07/12/2022	2023.01	07/12/2022 02:50:03 PM Eastern Daylight Time	08/05/2022 12:32:14 PM Eastern Daylight Time	08/05/2022 12:31:44 PM Eastern Daylight Time			08/05/2022 12:55:48 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	01	01		1			H9001	031	18	2023	Massachusetts except Dukes and Nantucket Counties	BAR, BER, BRI, ESS, MID, NOR, PLY and SUF Counties	2		2			2									fallonhealth.org/pharmacyfinder	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	5	1						07/12/2022	2023.01	07/12/2022 02:42:03 PM Eastern Daylight Time	08/05/2022 12:32:18 PM Eastern Daylight Time	08/05/2022 12:31:49 PM Eastern Daylight Time			08/05/2022 12:55:48 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	2023	Worcester County		2		2			2									fallonhealth.org/pharmacyfinder	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	036	0	1	01	01	H9001_036_0	5	1						07/12/2022	2023.01	07/12/2022 02:43:08 PM Eastern Daylight Time	08/05/2022 12:32:23 PM Eastern Daylight Time	08/05/2022 12:31:53 PM Eastern Daylight Time			08/05/2022 12:55:48 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	2023	Worcester County		2		2			2									fallonhealth.org/pharmacyfinder	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	038	0	1	01	01	H9001_038_0	6	1						08/04/2022	2023.01	08/04/2022 04:34:30 PM Eastern Daylight Time	08/05/2022 12:32:27 PM Eastern Daylight Time	08/05/2022 12:31:59 PM Eastern Daylight Time			08/05/2022 12:55:48 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	01	01		1			H9001	038	0	2023	Massachusetts except Dukes and Nantucket counties		2		2			2									fallonhealth.org/pharmacyfinder	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	039	0	1	01	01	H9001_039_0	4	1				0	0	07/12/2022	2023.01	07/12/2022 02:46:14 PM Eastern Daylight Time	06/06/2022 02:00:18 PM Eastern Daylight Time				07/12/2022 05:10:21 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	039	0	2023	Massachusetts except Dukes and Nantucket counties		2		2			2									fallonhealth.org/pharmacyfinder	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	040	0	1	01	01	H9001_040_0	6	1						07/12/2022	2023.01	07/12/2022 02:47:36 PM Eastern Daylight Time	08/05/2022 12:32:31 PM Eastern Daylight Time	08/05/2022 12:32:04 PM Eastern Daylight Time			08/05/2022 12:55:48 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	01	01		1			H9001	040	0	2023	Massachusetts except Dukes and Nantucket counties		2		2			2									fallonhealth.org/pharmacyfinder	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	3	1						05/06/2022	2023.01	05/06/2022 09:45:38 AM Eastern Daylight Time					06/06/2022 03:05:48 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-PD HMO (HMO)	01	01		1			H9001	803	0	2023	Full Service Area - Employer Groups		1	6708	2			2									fallonhealth.org/pharmacyfinder	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	3	1						05/06/2022	2023.01	05/06/2022 09:47:32 AM Eastern Daylight Time					06/06/2022 03:05:48 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MAPD calendar year HMO PSP (HMO)	01	01		1			H9001	804	0	2023	Full Service Area - Employer Groups		1	751	2			2									fallonhealth.org/pharmacyfinder	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	3	1				0	0	05/06/2022	2023.01	05/06/2022 09:49:25 AM Eastern Daylight Time					06/06/2022 03:05:48 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only HMO (HMO)	01	01		1			H9001	805	0	2023	Full Service Area - Employer Groups		1	24	2			2									fallonhealth.org/pharmacyfinder	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	3	1				0	0	05/06/2022	2023.01	05/06/2022 09:51:09 AM Eastern Daylight Time					06/06/2022 03:05:48 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only non-calendar HMO (HMO)	01	01		1			H9001	806	0	2023	Full Service Area - Employer Groups		1	24	2			2									fallonhealth.org/pharmacyfinder	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	3	1				0	0	05/06/2022	2023.01	05/06/2022 09:52:53 AM Eastern Daylight Time					06/06/2022 03:05:48 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only HMO PSP (HMO)	01	01		1			H9001	807	0	2023	Full Service Area - Employer Groups		1	24	2			2									fallonhealth.org/pharmacyfinder	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	3	1				0	0	05/06/2022	2023.01	05/06/2022 09:54:27 AM Eastern Daylight Time					06/06/2022 03:05:48 PM 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	2023	Full Service Area - Employer Groups		1	24	2			2									fallonhealth.org/pharmacyfinder	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	02	01	H9003_001_0	6	1						08/04/2022	2023.01	08/04/2022 09:36:20 AM Pacific Daylight Time	08/04/2022 02:34:50 PM Pacific Daylight Time	08/04/2022 02:34:50 PM Pacific Daylight Time			08/04/2022 02:42:55 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO-POS)	01	02		1			H9003	001	0	2023	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	02	01	H9003_006_0	6	1						08/04/2022	2023.01	08/04/2022 09:29:45 AM Pacific Daylight Time	08/04/2022 02:34:49 PM Pacific Daylight Time	08/04/2022 02:34:49 PM Pacific Daylight Time			08/04/2022 02:42:55 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Standard (HMO-POS)	01	02		1			H9003	006	0	2023	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	02	01	H9003_007_0	5	1						07/15/2022	2023.01	07/15/2022 11:25:18 AM Pacific Daylight Time	08/04/2022 02:34:49 PM Pacific Daylight Time	08/04/2022 02:34:49 PM Pacific Daylight Time			08/04/2022 02:42:55 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Standard Lane (HMO-POS)	01	02		1			H9003	007	0	2023	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	02	01	H9003_008_0	5	1						08/04/2022	2023.01	08/04/2022 09:46:11 AM Pacific Daylight Time	08/04/2022 02:34:49 PM Pacific Daylight Time	08/04/2022 02:34:49 PM Pacific Daylight Time			08/04/2022 02:42:55 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Value Lane (HMO-POS)	01	02		1			H9003	008	0	2023	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	02	01	H9003_009_0	6	1						08/04/2022	2023.01	08/04/2022 12:39:39 PM Pacific Daylight Time	08/04/2022 02:34:50 PM Pacific Daylight Time	08/04/2022 02:34:50 PM Pacific Daylight Time			08/04/2022 02:42:55 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Value (HMO-POS)	01	02		1			H9003	009	0	2023	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	3	1						05/04/2022	2023.01	05/04/2022 02:36:21 PM Pacific Daylight Time					06/03/2022 12:49:51 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Employer Group Only with Part D (HMO)	01	01		1			H9003	801	0	2023	Portland Metro, SW WA, Marion and Lane Counties		1	238789	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	3	1				0	0	05/04/2022	2023.01	05/04/2022 02:36:51 PM Pacific Daylight Time					06/03/2022 12:49:51 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Employer Group Only without Part D (HMO)	01	01		1			H9003	802	0	2023	Portland Metro, SW WA, Marion and Lane Counties		1	43342	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	3	1						05/04/2022	2023.01	05/04/2022 02:37:12 PM Pacific Daylight Time					06/03/2022 12:49:51 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H9003	805	0	2023	Portland Metro, SW WA, Marion and Lane Counties		1	53952	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	9	1					1	08/04/2022	2023.01	08/04/2022 09:22:03 PM Central Daylight Time	08/09/2022 03:40:52 PM Central Daylight Time	08/04/2022 01:50:47 PM Central Daylight Time			08/10/2022 11:55:20 AM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Choice (PPO)	01	04		1			H9042	001	1	2023	Indiana (Partial)	Columbus, N Vernon, S Indianapolis, Terre Haute	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		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		2					2						2			
H9042	001	2	1	04	01	H9042_001_2	10	1					1	08/04/2022	2023.01	08/04/2022 09:22:48 PM Central Daylight Time	08/09/2022 03:41:52 PM Central Daylight Time	08/04/2022 01:51:41 PM Central Daylight Time			08/10/2022 11:38:16 AM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Choice (PPO)	01	04		1			H9042	001	2	2023	Indiana (Partial)	Anderson, Evansville, Indianapolis	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		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		2					2						2			
H9042	002	1	1	04	01	H9042_002_1	5	1					1	08/04/2022	2023.01	08/04/2022 06:11:11 PM Central Daylight Time	08/04/2022 05:48:13 PM Central Daylight Time	08/04/2022 01:52:34 PM Central Daylight Time			08/04/2022 10:00:23 PM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Choice Plus (PPO)	01	04		1			H9042	002	1	2023	Indiana (Partial)	Columbus, N Vernon, S Indianapolis, Terre Haute	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		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		2					2						2			
H9042	002	2	1	04	01	H9042_002_2	5	1					1	08/04/2022	2023.01	08/04/2022 06:11:47 PM Central Daylight Time	08/04/2022 05:49:31 PM Central Daylight Time	08/04/2022 01:53:29 PM Central Daylight Time			08/04/2022 10:00:23 PM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Choice Plus (PPO)	01	04		1			H9042	002	2	2023	Indiana (Partial)	Anderson, Evansville, Indianapolis	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		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		(800)743-3333		(711)-		2					2						2			
H9047	013	0	2	01	01	H9047_013_0	10	1					0	07/14/2022	2023.01	07/14/2022 10:20:37 AM Pacific Daylight Time	08/05/2022 08:15:16 AM Pacific Daylight Time	08/05/2022 08:12:42 AM Pacific Daylight Time			08/05/2022 08:35:24 AM 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	2023	Portland Metro and Willamette Valley		2		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	11	1				0	0	07/14/2022	2023.01	07/14/2022 10:20:45 AM Pacific Daylight Time	06/06/2022 05:57:43 PM Pacific Daylight Time				07/14/2022 10:26:04 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Focus Medical (HMO)	01	01		1			H9047	033	0	2023	Portland, Willamette Valley, Clark, Central OR		2		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	13	1				0	0	06/03/2022	2023.01	06/03/2022 07:34:27 AM Pacific Daylight Time	06/22/2022 11:26:30 AM Pacific Daylight Time				07/14/2022 10:26:04 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Reverence (HMO-POS)	01	02		1			H9047	035	0	2023	Portland, Will Valley, Clark, Central OR, SE WA		2		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	15	1					1	08/04/2022	2023.01	08/04/2022 11:11:34 AM Pacific Daylight Time	08/05/2022 08:15:17 AM Pacific Daylight Time	08/05/2022 08:12:43 AM Pacific Daylight Time			08/05/2022 08:35:24 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Prime + RX (HMO)	01	01		1			H9047	037	0	2023	Portland Metro		2		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	15	1	2	1			0	08/04/2022	2023.01	08/04/2022 11:19:04 AM Pacific Daylight Time	08/05/2022 08:15:17 AM Pacific Daylight Time	08/05/2022 08:12:41 AM Pacific Daylight Time			08/05/2022 08:35:24 AM 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	2023	Clackamas, Multnomah, Washington		2		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	054	0	1	01	01	H9047_054_0	12	1					1	08/04/2022	2023.01	08/04/2022 11:17:58 AM Pacific Daylight Time	08/05/2022 08:15:17 AM Pacific Daylight Time	08/05/2022 08:12:41 AM Pacific Daylight Time			08/05/2022 08:35:24 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Timber + RX (HMO)	01	01		1			H9047	054	0	2023	Willamette Valley, Clark, Central OR		2		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	16	1					1	08/04/2022	2023.01	08/04/2022 11:18:46 AM Pacific Daylight Time	08/05/2022 08:15:15 AM Pacific Daylight Time	08/05/2022 08:12:42 AM Pacific Daylight Time			08/05/2022 08:35:24 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Bridge + RX (HMO-POS)	01	02		1			H9047	059	0	2023	Portland, Willamette Valley, Clark, Central OR		2		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	15	1					1	08/04/2022	2023.01	08/04/2022 11:19:41 AM Pacific Daylight Time	08/05/2022 08:15:15 AM Pacific Daylight Time	08/05/2022 08:12:42 AM Pacific Daylight Time			08/05/2022 08:35:24 AM 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	2023	Spokane, Snohomish counties		2		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	12	1					1	08/04/2022	2023.01	08/04/2022 11:20:11 AM Pacific Daylight Time	08/05/2022 08:15:15 AM Pacific Daylight Time	08/05/2022 08:12:42 AM Pacific Daylight Time			08/05/2022 08:35:24 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Pine + RX (HMO)	01	01		1			H9047	063	0	2023	Spokane, Snohomish counties		2		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	064	0	1	01	01	H9047_064_0	12	1					1	08/04/2022	2023.01	08/04/2022 11:21:04 AM Pacific Daylight Time	08/05/2022 08:15:15 AM Pacific Daylight Time	08/05/2022 08:12:42 AM Pacific Daylight Time			08/05/2022 08:35:24 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Extra + Rx (HMO)	01	01		1			H9047	064	0	2023	Portland, Will Valley, Clark, Central OR		2		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	065	0	1	02	01	H9047_065_0	15	1					1	06/22/2022	2023.01	06/22/2022 10:27:47 AM Pacific Daylight Time	08/05/2022 08:15:16 AM Pacific Daylight Time	08/05/2022 08:12:42 AM Pacific Daylight Time			08/05/2022 08:35:24 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Choice + Rx (HMO-POS)	01	02		1			H9047	065	0	2023	Portland, Willamette Valley, Clark, Central OR		2		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	066	0	1	01	01	H9047_066_0	12	1					1	08/04/2022	2023.01	08/04/2022 11:22:58 AM Pacific Daylight Time	08/05/2022 08:15:16 AM Pacific Daylight Time	08/05/2022 08:12:42 AM Pacific Daylight Time			08/05/2022 08:35:24 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Sycamore + Rx (HMO)	01	01		1			H9047	066	0	2023	Orange County		2		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	11	1						06/03/2022	2023.01	06/03/2022 07:33:02 AM Pacific Daylight Time					06/06/2022 06:03:23 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	2023	Portland, Willamette Valley,Central OR, Washington		1	16320	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)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;14d;16b;17a;18a;	1					1				
H9047	805	0	1	02	01	H9047_805_0	11	1						06/03/2022	2023.01	06/03/2022 07:33:20 AM Pacific Daylight Time					06/06/2022 06:03:23 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	2023	Portland, Willamette Valley,Central OR, Washington		1	1	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)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;14d;16b;17a;18a;	1	1	1a;1b;2;5;7c;7e;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;14a;15;16b;	2		1				
H9047	808	0	1	01	01	H9047_808_0	11	1						06/03/2022	2023.01	06/03/2022 07:33:34 AM Pacific Daylight Time					06/06/2022 06:03:23 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	2023	Portland, Willamette Valley,Central OR, Washington		1	90252	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)-		1	1	1a;1b;2;5;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;14d;16b;17a;18a;	1					1				
H9047	809	0	1	02	01	H9047_809_0	11	1						06/03/2022	2023.01	06/03/2022 07:33:47 AM Pacific Daylight Time					06/06/2022 06:03:23 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	2023	Portland, Willamette Valley,Central OR, Washington		1	54384	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)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;14d;16b;17a;18a;	1	1	1a;1b;2;5;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;14a;15;16b;	2		1				
H9052	001	0	1	20	08	H9052_001_0	1	1						06/06/2022	2023.01	06/06/2022 09:49:38 AM Eastern Daylight Time		06/03/2022 11:01:28 AM Eastern Daylight Time			06/06/2022 09:50:29 AM 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	2023	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						06/06/2022	2023.01	06/06/2022 09:49:51 AM Eastern Daylight Time		06/03/2022 11:01:28 AM Eastern Daylight Time			06/06/2022 09:50:29 AM Eastern Daylight Time	REGION VII AREA AGENCY ON AGING	Sunrise PACE	https://region7aaa.org/	Medicare Only 02 (PACE)	08	20		1			H9052	002	0	2023	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	5	1	2	1	1		0	07/13/2022	2023.01	07/13/2022 01:48:22 PM Eastern Daylight Time	08/04/2022 06:18:32 PM Eastern Daylight Time	08/04/2022 06:33:16 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2		1	08/01/2022	2023.01	08/01/2022 03:53:12 PM Eastern Daylight Time	08/04/2022 06:18:33 PM Eastern Daylight Time	08/04/2022 06:33:19 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:26:07 PM Eastern Daylight Time	08/04/2022 06:18:34 PM Eastern Daylight Time	08/04/2022 06:33:22 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2		0	08/01/2022	2023.01	08/01/2022 12:27:22 PM Eastern Daylight Time	08/04/2022 06:18:36 PM Eastern Daylight Time	08/04/2022 06:33:25 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	006	0	1	01	01	H9065_006_0	7	1			2		0	07/11/2022	2023.01	07/11/2022 10:30:58 AM Eastern Daylight Time	08/04/2022 06:18:37 PM Eastern Daylight Time	08/04/2022 06:33:27 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2		0	07/11/2022	2023.01	07/11/2022 10:31:13 AM Eastern Daylight Time	08/04/2022 06:18:38 PM Eastern Daylight Time	08/04/2022 06:33:30 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	08/01/2022	2023.01	08/01/2022 12:28:17 PM Eastern Daylight Time	08/04/2022 06:18:40 PM Eastern Daylight Time	08/04/2022 06:33:33 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	08/05/2022	2023.01	08/05/2022 02:32:46 PM Eastern Daylight Time	08/05/2022 10:26:55 PM Eastern Daylight Time	08/05/2022 10:26:55 PM Eastern Daylight Time			08/05/2022 10:29:42 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	2023	Upstate New York		2		2			1	3		1					1	www.envisionrx.com	www.elixirsolutions.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	6	1		1				08/05/2022	2023.01	08/05/2022 03:42:38 PM Eastern Daylight Time	08/05/2022 10:26:55 PM Eastern Daylight Time	08/05/2022 10:26:55 PM Eastern Daylight Time			08/05/2022 10:29:42 PM 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	2023	Upstate New York		2		2			1	1	1							www.envisionrx.com	www.elixirsolutions.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	6	1	2	1			0	08/05/2022	2023.01	08/05/2022 02:33:17 PM Eastern Daylight Time	08/05/2022 10:26:55 PM Eastern Daylight Time	08/05/2022 10:26:55 PM Eastern Daylight Time			08/05/2022 10:29:42 PM 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	2023	Upstate New York		2		2			1	3		2					1	www.envisionrx.com	www.elixirsolutions.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						05/31/2022	2023.01	05/31/2022 11:23:52 AM Eastern Daylight Time		05/31/2022 11:13:16 AM Eastern Daylight Time			05/31/2022 11:27:09 AM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE (PACE)	08	20		1			H9068	001	0	2023	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						05/31/2022	2023.01	05/31/2022 11:24:29 AM Eastern Daylight Time		05/31/2022 11:13:16 AM Eastern Daylight Time			05/31/2022 11:27:09 AM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE Medicare Only (PACE)	08	20		1			H9068	002	0	2023	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	003	0	1	04	01	H9070_003_0	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:07:37 PM Eastern Daylight Time	08/03/2022 03:49:58 PM Eastern Daylight Time	07/30/2022 09:58:08 AM Eastern Daylight Time			08/04/2022 11:40:13 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-003 (PPO)	01	04		1			H9070	003	0	2023	Select Counties in Kansas and Missouri		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:07:59 PM Eastern Daylight Time	08/03/2022 03:52:02 PM Eastern Daylight Time	07/30/2022 09:58:34 AM Eastern Daylight Time			08/04/2022 11:40:13 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-004 (PPO)	01	04		1			H9070	004	0	2023	Select Counties in Kansas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	05/31/2022	2023.01	05/31/2022 02:26:30 PM Eastern Daylight Time	08/03/2022 03:52:34 PM Eastern Daylight Time	07/30/2022 09:59:00 AM Eastern Daylight Time			08/04/2022 11:40:13 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-005 (PPO)	01	04		1			H9070	005	0	2023	Select Counties in Arkansas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:08:34 PM Eastern Daylight Time	08/03/2022 03:54:55 PM Eastern Daylight Time	07/30/2022 09:59:26 AM Eastern Daylight Time			08/04/2022 11:40:13 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-006 (PPO)	01	04		1			H9070	006	1	2023	Select Counties in Oklahoma	Oklahoma Rural	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:08:56 PM Eastern Daylight Time	08/03/2022 03:56:14 PM Eastern Daylight Time	07/30/2022 09:59:50 AM Eastern Daylight Time			08/04/2022 11:40:13 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-006 (PPO)	01	04		1			H9070	006	2	2023	Select Counties in Oklahoma	Oklahoma City	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			1		1	08/01/2022	2023.01	08/01/2022 01:09:13 PM Eastern Daylight Time	08/03/2022 03:57:34 PM Eastern Daylight Time	07/30/2022 10:00:16 AM Eastern Daylight Time			08/04/2022 11:40:13 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-006 (PPO)	01	04		1			H9070	006	3	2023	Select Counties in Oklahoma	Tulsa	2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9082	010	0	1	01	01	H9082_010_0	7	1					1	08/04/2022	2023.01	08/04/2022 02:08:51 PM Pacific Daylight Time	08/04/2022 06:18:44 PM Pacific Daylight Time	08/01/2022 10:54:20 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	7	1					1	08/04/2022	2023.01	08/04/2022 01:35:49 PM Pacific Daylight Time	08/04/2022 06:19:10 PM Pacific Daylight Time	08/01/2022 03:35:50 PM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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	8	1					1	08/16/2022	2023.01	08/16/2022 03:05:28 PM Central Daylight Time	08/05/2022 11:15:31 AM Central Daylight Time	08/04/2022 01:13:14 PM Central Daylight Time			08/16/2022 03:08:19 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.deancare.com/medicareadvantage	Dean Advantage Assurance (HMO-POS)	01	02		1			H9096	001	0	2023	South Central Wisconsin		2		2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	08/11/2022	2023.01	08/11/2022 08:17:40 PM Central Daylight Time	08/05/2022 11:18:19 AM Central Daylight Time	08/04/2022 01:13:45 PM Central Daylight Time			08/11/2022 09:15:34 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.deancare.com/medicareadvantage	Dean Advantage Balance (HMO-POS)	01	02		1			H9096	002	0	2023	South Central Wisconsin		2		2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	08/11/2022	2023.01	08/11/2022 08:18:39 PM Central Daylight Time	08/05/2022 11:21:00 AM Central Daylight Time	08/04/2022 01:14:11 PM Central Daylight Time			08/11/2022 09:15:34 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.deancare.com/medicareadvantage	Dean Advantage Essential (HMO)	01	01		1			H9096	004	0	2023	South Central Wisconsin		2		2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	08/11/2022	2023.01	08/11/2022 08:19:41 PM Central Daylight Time	08/05/2022 11:22:21 AM Central Daylight Time	08/04/2022 01:14:37 PM Central Daylight Time			08/11/2022 09:15:34 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.deancare.com/medicareadvantage	Dean Advantage Complete (HMO)	01	01		1			H9096	005	0	2023	South Central Wisconsin		2		2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	8	1					1	08/11/2022	2023.01	08/11/2022 09:13:51 PM Central Daylight Time	08/05/2022 11:20:38 AM Central Daylight Time	08/04/2022 01:15:03 PM Central Daylight Time			08/11/2022 09:15:34 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.prevea360.com/medicareadvantage	Prevea360 Essential (HMO-POS)	01	02		1			H9096	006	0	2023	North Eastern Wisconsin		2		2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	07/18/2022	2023.01	07/18/2022 02:28:34 PM Central Daylight Time	06/04/2022 11:21:41 PM Central Daylight Time				07/18/2022 03:20:59 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.deancare.com/medicareadvantage	Dean Advantage Harmony (HMO-POS)	01	02		1			H9096	010	0	2023	South Central Wisconsin		2		2			2									deancare.com/doctors	www.deancare.com/medicare	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	07/18/2022	2023.01	07/18/2022 02:29:26 PM Central Daylight Time	06/04/2022 11:20:38 PM Central Daylight Time				07/18/2022 03:20:59 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.prevea360.com/medicareadvantage	Prevea360 Harmony (HMO-POS)	01	02		1			H9096	011	0	2023	North Eastern Wisconsin		2		2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	08/11/2022	2023.01	08/11/2022 08:21:24 PM Central Daylight Time	08/05/2022 11:21:22 AM Central Daylight Time	08/04/2022 01:15:29 PM Central Daylight Time			08/11/2022 09:15:34 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	2023	Fond du Lac and Dodge Counties		2		2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	013	0	1	02	01	H9096_013_0	7	1					1	08/11/2022	2023.01	08/11/2022 08:22:14 PM Central Daylight Time	08/05/2022 11:18:34 AM Central Daylight Time	08/04/2022 01:15:56 PM Central Daylight Time			08/11/2022 09:15:34 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.prevea360.com/medicareadvantage	Prevea360 FlexSpend (HMO-POS)	01	02		1			H9096	013	0	2023	North Eastern Wisconsin		2		2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	801	0	1	01	01	H9096_801_0	3	1						05/02/2022	2023.01	05/02/2022 02:02:42 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	South Central Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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						05/02/2022	2023.01	05/02/2022 02:02:21 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	South Central Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	05/02/2022	2023.01	05/02/2022 02:02:01 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	South Central Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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						05/02/2022	2023.01	05/02/2022 01:59:50 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	South Central Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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						05/02/2022	2023.01	05/02/2022 01:59:16 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	South Central Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	05/02/2022	2023.01	05/02/2022 01:58:48 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	South Central Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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						05/02/2022	2023.01	05/02/2022 01:58:23 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	North Eastern Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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						05/02/2022	2023.01	05/02/2022 01:57:51 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	North Eastern Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	05/02/2022	2023.01	05/02/2022 01:57:29 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	North Eastern Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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						05/02/2022	2023.01	05/02/2022 01:57:07 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	North Eastern Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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						05/02/2022	2023.01	05/02/2022 01:56:43 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	North Eastern Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	05/02/2022	2023.01	05/02/2022 01:56:15 PM Central Daylight Time					06/05/2022 08:00:26 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	2023	North Eastern Wisconsin		1	1	2			2									www.deancare.com/medicare	www.deancare.com/medicare	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	11	1		1			1	08/04/2022	2023.01	08/04/2022 04:47:45 PM Pacific Daylight Time	08/04/2022 11:53:03 AM Pacific Daylight Time	08/02/2022 10:10:40 PM Pacific Daylight Time			08/04/2022 06:42:18 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	2023	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	7	1	2	1	1		0	08/04/2022	2023.01	08/04/2022 11:37:00 AM Central Daylight Time	08/05/2022 10:43:20 AM Eastern Daylight Time	08/05/2022 10:43:19 AM Eastern Daylight Time			08/05/2022 12:37:34 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Healthy Blue + Medicare (HMO D-SNP)	01	01		1			H9147	001	0	2023	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		(866)760-4610		(866)760-4610		(800)725-7710		(800)725-7710		(866)760-4610		(866)760-4610		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9153	001	0	1	01	01	H9153_001_0	8	1		1				08/05/2022	2023.01	08/05/2022 04:55:17 PM Central Daylight Time	08/05/2022 03:52:25 PM Central Daylight Time	08/01/2022 01:26:18 PM Central Daylight Time			08/05/2022 05:08:37 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	2023	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						05/31/2022	2023.01	05/31/2022 01:55:40 PM Eastern Daylight Time		05/31/2022 01:47:10 PM Eastern Daylight Time			05/31/2022 01:57:42 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	2023	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						05/31/2022	2023.01	05/31/2022 01:56:19 PM Eastern Daylight Time		05/31/2022 01:47:22 PM Eastern Daylight Time			05/31/2022 01:57:42 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	2023	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	15	1		1				08/04/2022	2023.01	08/04/2022 05:44:44 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time	08/04/2022 09:39:24 PM Eastern Daylight Time			08/04/2022 09:42:14 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	2023	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	10	1			2		1	08/03/2022	2023.01	08/03/2022 08:30:28 PM Eastern Daylight Time	08/03/2022 10:00:26 AM Eastern Daylight Time	08/01/2022 07:59:24 AM Eastern Daylight Time			08/03/2022 08:44:13 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	2023	Southeastern PA, Central PA and Eastern PA		2		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	10	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 08:31:45 PM Eastern Daylight Time	08/03/2022 10:01:18 AM Eastern Daylight Time	08/01/2022 08:02:24 AM Eastern Daylight Time			08/03/2022 08:44:13 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	2023	Southeastern PA, Central PA and Eastern PA		2		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	10	1			2		1	08/03/2022	2023.01	08/03/2022 08:32:34 PM Eastern Daylight Time	08/03/2022 10:04:08 AM Eastern Daylight Time	08/01/2022 08:04:50 AM Eastern Daylight Time			08/03/2022 08:44:13 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	2023	Southeastern PA, Central PA and Eastern PA		2		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	013	0	1	02	01	H9207_013_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 08:33:29 PM Eastern Daylight Time	08/03/2022 10:05:10 AM Eastern Daylight Time	08/01/2022 08:05:46 AM Eastern Daylight Time			08/03/2022 08:44:13 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Silver (HMO-POS)	01	02		1			H9207	013	0	2023	Camden, Burlington and Gloucester Counties		2		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	014	0	1	02	01	H9207_014_0	10	1			2		1	08/03/2022	2023.01	08/03/2022 08:34:20 PM Eastern Daylight Time	08/03/2022 10:07:16 AM Eastern Daylight Time	08/01/2022 08:07:04 AM Eastern Daylight Time			08/03/2022 08:44:13 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Platinum (HMO-POS)	01	02		1			H9207	014	0	2023	Camden, Burlington and Gloucester Counties		2		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			2			08/04/2022	2023.01	08/04/2022 07:29:29 PM Eastern Daylight Time	08/04/2022 06:18:41 PM Eastern Daylight Time	08/04/2022 06:33:35 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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	5	1			2			07/11/2022	2023.01	07/11/2022 10:32:01 AM Eastern Daylight Time	08/04/2022 06:18:42 PM Eastern Daylight Time	08/04/2022 06:33:38 PM Eastern Daylight Time			08/04/2022 07:47:00 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	2023	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			
H9231	001	0	1	04	01	H9231_001_0	11	1					1	08/03/2022	2023.01	08/03/2022 03:38:25 PM US Eastern Daylight Time	08/04/2022 10:00:27 AM Eastern Daylight Time	07/31/2022 02:07:30 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Devoted Health	www.Devoted.com	Devoted CHOICE Tennessee (PPO)	01	04		1			H9231	001	0	2023	Nashville		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			
H9239	001	0	1	48	05	H9239_001_0	4	1						06/06/2022	2023.01	06/06/2022 10:02:42 AM Central Daylight Time					06/06/2022 10:17:00 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.uhccommunityplan.com	UnitedHealthcare Connected for One Care (Medicare-Medicaid Plan)	05	48		1			H9239	001	0	2023	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)-																
H9252	001	0	1	20	08	H9252_001_0	1	1						11/30/2022	2023.01	11/30/2022 03:32:46 PM Eastern Standard Time		11/29/2022 05:53:47 PM Eastern Standard Time			11/30/2022 03:33:49 PM Eastern Standard Time	MOUNT SINAI ELDERCARE, INC.	Mount Sinai Eldercare	msmc.com-eldercare	Mount Sinai Eldercare-Dual Eligible (PACE)	08	20		1			H9252	001	0	2023	Miami-Dade		2		2			2									www.msmc.com	N/A - no formulary												(786)548-5560				(786)548-5560												(800)955-8771				(800)955-8771																
H9252	002	0	1	20	08	H9252_002_0	1	1						11/30/2022	2023.01	11/30/2022 03:33:00 PM Eastern Standard Time		11/29/2022 05:53:47 PM Eastern Standard Time			11/30/2022 03:33:49 PM Eastern Standard Time	MOUNT SINAI ELDERCARE, INC.	Mount Sinai Eldercare	msmc.com-eldercare	Mount Sinai Eldercare-Medicare Only (PACE)	08	20		1			H9252	002	0	2023	Miami-Dade		2		2			2									www.msmc.com	N/A - no formulary												(786)548-5560				(786)548-5560												(800)955-8771				(800)955-8771																
H9258	001	0	1	01	01	H9258_001_0	4	1						08/02/2022	2023.01	08/02/2022 09:43:53 AM Eastern Daylight Time	08/03/2022 07:23:51 PM Central Daylight Time	07/30/2022 09:41:49 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H9258	001	0	2023	All counties in RI		2		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						06/01/2022	2023.01	06/01/2022 01:10:50 PM Eastern Daylight Time		05/31/2022 10:53:26 AM Eastern Daylight Time			06/01/2022 01:13:56 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	2023	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						06/01/2022	2023.01	06/01/2022 01:09:19 PM Eastern Daylight Time		05/31/2022 10:53:26 AM Eastern Daylight Time			06/01/2022 01:13:56 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	2023	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	1	1						05/10/2022	2023.01	05/10/2022 11:20:20 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	WellCare Group Medicare Advantage (HMO)	01	01		1			H9276	805	0	2023	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		(844)917-0175		(844)917-0175		(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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:20:25 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	WellCare Group Medicare Advantage (HMO)	01	01		1			H9276	806	0	2023	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		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:20:30 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	WellCare Group Medicare Advantage (HMO)	01	01		1			H9276	807	0	2023	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		(844)917-0175		(844)917-0175		(877)935-8022		(877)935-8022		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	004	0	1	01	01	H9302_004_0	4	1				0	0	06/03/2022	2023.01	06/03/2022 04:51:03 PM Pacific Daylight Time	06/04/2022 03:59:55 PM Pacific Daylight Time				06/04/2022 04:25:58 PM 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	2023	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	6	1					1	07/08/2022	2023.01	07/08/2022 01:25:01 PM Pacific Daylight Time	08/05/2022 12:04:51 PM Pacific Daylight Time	08/05/2022 12:04:51 PM Pacific Daylight Time			08/05/2022 12:22:51 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	2023	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	7	1					1	08/22/2022	2023.01	08/22/2022 11:22:36 AM Pacific Daylight Time	08/05/2022 12:04:52 PM Pacific Daylight Time	08/05/2022 12:04:52 PM Pacific Daylight Time			08/22/2022 12:03:40 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	2023	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			
H9306	001	0	1	01	01	H9306_001_0	6	1					0	08/05/2022	2023.01	08/05/2022 12:40:14 PM Eastern Daylight Time	08/05/2022 04:49:03 PM Eastern Daylight Time	08/05/2022 04:49:03 PM Eastern Daylight Time			08/05/2022 06:10:50 PM Eastern Daylight Time	ALTERWOOD ADVANTAGE, INC.	Alterwood Advantage	www.alterwoodadvantage.com	Alterwood Advantage Choice (HMO)	01	01		1			H9306	001	0	2023	Select Maryland Counties		2		2			2									www.alterwoodadvantage.com	www.alterwoodadvantage.com	www.alterwoodadvantage.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9306	002	0	1	01	01	H9306_002_0	5	1					0	08/05/2022	2023.01	08/05/2022 05:59:58 PM Eastern Daylight Time	08/05/2022 06:04:41 PM Eastern Daylight Time	08/05/2022 06:04:46 PM Eastern Daylight Time			08/05/2022 06:10:50 PM Eastern Daylight Time	ALTERWOOD ADVANTAGE, INC.	Alterwood Advantage	www.alterwoodadvantage.com	Alterwood Advantage Choice Plus (HMO)	01	01		1			H9306	002	0	2023	Select Maryland Counties		2		2			2									www.alterwoodadvantage.com	www.alterwoodadvantage.com	www.alterwoodadvantage.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9306	003	0	1	01	01	H9306_003_0	4	1				0	0	07/09/2022	2023.01	07/09/2022 11:31:34 AM Eastern Daylight Time	06/16/2022 04:33:37 PM Eastern Daylight Time				07/11/2022 02:13:02 PM Eastern Daylight Time	ALTERWOOD ADVANTAGE, INC.	Alterwood Advantage	www.alterwoodadvantage.com	Alterwood Advantage Freedom (HMO)	01	01		1			H9306	003	0	2023	Select Maryland Counties		2		2			2									www.alterwoodadvantage.com	www.alterwoodadvantage.com	www.alterwoodadvantage.com	(866)675-3944		(667)262-9412		(866)273-7834		(866)273-7834										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9306	004	0	1	01	01	H9306_004_0	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 12:43:19 PM Eastern Daylight Time	08/05/2022 04:49:03 PM Eastern Daylight Time	08/05/2022 04:49:03 PM Eastern Daylight Time			08/05/2022 06:10:50 PM Eastern Daylight Time	ALTERWOOD ADVANTAGE, INC.	Alterwood Advantage	www.alterwoodadvantage.com	Alterwood Advantage Dual Secure (HMO D-SNP)	01	01		1			H9306	004	0	2023	Select Maryland Counties		2		2			1	3		2					1	www.alterwoodadvantage.com	www.alterwoodadvantage.com	www.alterwoodadvantage.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9306	005	0	1	01	01	H9306_005_0	8	1					0	08/05/2022	2023.01	08/05/2022 12:40:31 PM Eastern Daylight Time	08/05/2022 04:49:03 PM Eastern Daylight Time	08/05/2022 04:49:03 PM Eastern Daylight Time			08/05/2022 06:10:50 PM Eastern Daylight Time	ALTERWOOD ADVANTAGE, INC.	Alterwood Advantage	www.alterwoodadvantage.com	Alterwood Advantage Select (HMO)	01	01		1			H9306	005	0	2023	Select Maryland Counties		2		2			2									www.alterwoodadvantage.com	www.alterwoodadvantage.com	www.alterwoodadvantage.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9323	001	0	1	20	08	H9323_001_0	1	1						05/27/2022	2023.01	05/27/2022 02:34:11 PM Eastern Daylight Time		05/27/2022 02:19:22 PM Eastern Daylight Time			05/27/2022 02:36:20 PM Eastern Daylight Time	ACUTE CARE HEALTH SYSTEM, LLC	Beacon of LIFE	beaconpace.com	Beacon of LIFE (PACE)	08	20		1			H9323	001	0	2023	Monmouth & Ocean County		2		2			2									NA	NA										(732)592-3400		(732)592-3400		(732)592-3400		(732)592-3400										(732)532-3400		(732)592-3400		(732)592-3400		(732)592-3400																
H9323	002	0	1	20	08	H9323_002_0	1	1						05/27/2022	2023.01	05/27/2022 02:34:34 PM Eastern Daylight Time		05/27/2022 02:19:05 PM Eastern Daylight Time			05/27/2022 02:36:20 PM Eastern Daylight Time	ACUTE CARE HEALTH SYSTEM, LLC	Beacon of LIFE	beaconpace.com	Beacon of LIFE (PACE)	08	20		1			H9323	002	0	2023	Monmouth & Ocean 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			2			08/01/2022	2023.01	08/01/2022 12:42:49 PM Eastern Daylight Time	08/03/2022 08:13:34 PM Eastern Daylight Time	07/30/2022 10:42:21 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select counties in MO		2		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	5	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 01:52:29 PM Eastern Daylight Time	08/03/2022 08:14:39 PM Eastern Daylight Time	07/30/2022 10:42:54 AM Eastern Daylight Time			08/04/2022 06:08:31 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	2023	Select counties in MO		2		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			2			08/03/2022	2023.01	08/03/2022 02:30:51 PM Eastern Daylight Time	08/03/2022 08:15:43 PM Eastern Daylight Time	07/30/2022 10:43:26 AM Eastern Daylight Time			08/04/2022 06:08:31 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H9335	005	0	2023	Select counties in MO		2		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			2			05/28/2022	2023.01	05/28/2022 10:02:14 PM Eastern Daylight Time	08/03/2022 08:16:47 PM Eastern Daylight Time	07/30/2022 10:43:57 AM Eastern Daylight Time			08/04/2022 06:08:31 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H9335	006	0	2023	Select counties in MO		2		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	5	1						08/01/2022	2023.01	08/01/2022 01:22:47 PM Central Daylight Time	08/03/2022 09:22:26 PM Eastern Daylight Time	07/30/2022 10:44:29 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Seton Access Plus (PPO)	01	04		1			H9357	001	0	2023	Austin Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9357	002	0	1	04	01	H9357_002_0	5	1						08/01/2022	2023.01	08/01/2022 01:23:48 PM Central Daylight Time	08/03/2022 09:23:38 PM Eastern Daylight Time	07/30/2022 10:45:01 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Seton Access (PPO)	01	04		1			H9357	002	0	2023	Austin Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9357	003	0	1	04	01	H9357_003_0	5	1						08/01/2022	2023.01	08/01/2022 01:24:43 PM Central Daylight Time	08/03/2022 09:24:52 PM Eastern Daylight Time	07/30/2022 10:45:33 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Providence Access Plus (PPO)	01	04		1			H9357	003	0	2023	Waco Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9357	004	0	1	04	01	H9357_004_0	5	1						08/01/2022	2023.01	08/01/2022 01:25:35 PM Central Daylight Time	08/03/2022 09:26:07 PM Eastern Daylight Time	07/30/2022 10:46:04 AM Eastern Daylight Time			08/04/2022 05:05:18 PM Eastern Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Providence Access (PPO)	01	04		1			H9357	004	0	2023	Waco Area Counties		2		2			2									www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(833)705-1358		(833)705-1358		(866)281-2878		(866)281-2878		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9364	001	0	1	01	01	H9364_001_0	4	1						08/03/2022	2023.01	08/03/2022 02:21:17 PM Eastern Daylight Time	08/03/2022 07:25:02 PM Central Daylight Time	07/30/2022 09:46:36 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE OF MAINE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H9364	001	0	2023	All counties in ME		2		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	1		0	07/05/2022	2023.01	07/05/2022 11:50:15 AM Central Daylight Time	08/03/2022 07:26:15 PM Central Daylight Time	07/30/2022 09:47:09 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE OF MAINE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H9364	002	0	2023	All counties in ME		2		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	1		0	07/05/2022	2023.01	07/05/2022 11:53:52 AM Central Daylight Time	08/03/2022 07:27:26 PM Central Daylight Time	07/30/2022 09:47:42 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE OF MAINE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H9364	003	0	2023	All counties in ME		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:23:51 PM Eastern Daylight Time	08/03/2022 07:28:38 PM Central Daylight Time	07/30/2022 09:48:14 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE OF MAINE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H9364	004	0	2023	All counties in ME		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:35:03 PM Eastern Daylight Time	08/03/2022 08:07:18 PM Eastern Daylight Time	07/30/2022 10:48:46 AM Eastern Daylight Time			08/04/2022 06:10:56 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	2023	Select counties in KS		2		2			2									www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9387	002	0	1	04	01	H9387_002_0	3	1				0	0	05/29/2022	2023.01	05/29/2022 05:53:52 PM Eastern Daylight Time	06/03/2022 08:17:15 PM Eastern Daylight Time				07/15/2022 03:54:41 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	2023	Select counties in KS		2		2			2									www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H9387	004	0	1	04	01	H9387_004_0	5	1	2	1	1		0	07/12/2022	2023.01	07/12/2022 08:54:42 AM Eastern Daylight Time	08/03/2022 08:08:33 PM Eastern Daylight Time	07/30/2022 10:49:21 AM Eastern Daylight Time			08/04/2022 06:10:56 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellKS	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H9387	004	0	2023	Select Counties in Kansas		2		2			1	3		1					1	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(855)565-9519		(855)565-9519		(855)565-9519		(855)565-9519		(855)565-9519		(855)565-9519		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9403	001	0	1	01	01	H9403_001_0	6	1	2	1			0	08/03/2022	2023.01	08/03/2022 08:02:35 AM Central Daylight Time	08/04/2022 03:24:08 PM Central Daylight Time	08/04/2022 03:34:20 PM Central Daylight Time			08/04/2022 04:25:51 PM Central Daylight Time	CLEAR SPRING HEALTH (SC), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Deluxe Plan (HMO D-SNP)	01	01		1			H9403	001	0	2023	Select South Carolina Counties		2		2			1	3		1					1	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			
H9403	003	0	1	01	01	H9403_003_0	5	1		1			1	08/03/2022	2023.01	08/03/2022 08:03:23 AM Central Daylight Time	08/04/2022 03:24:58 PM Central Daylight Time	08/04/2022 03:34:52 PM Central Daylight Time			08/04/2022 04:25:51 PM Central Daylight Time	CLEAR SPRING HEALTH (SC), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Silver Plan (HMO C-SNP)	01	01		1			H9403	003	0	2023	Select South Carolina Counties		2		2			1	4			00000000000000000010000					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			
H9403	004	0	1	01	01	H9403_004_0	5	1					1	08/03/2022	2023.01	08/03/2022 08:06:51 AM Central Daylight Time	08/04/2022 03:25:45 PM Central Daylight Time	08/04/2022 03:35:22 PM Central Daylight Time			08/04/2022 04:25:51 PM Central Daylight Time	CLEAR SPRING HEALTH (SC), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Select Plan (HMO)	01	01		1			H9403	004	0	2023	Select South Carolina 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	2			
H9412	803	0	1	04	01	H9412_803_0	3	1						05/19/2022	2023.01	05/19/2022 10:05:35 AM Eastern Daylight Time					06/03/2022 05:40:15 PM 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	2023	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	5	1			2		1	08/05/2022	2023.01	08/05/2022 12:14:09 PM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time			08/05/2022 12:57:01 PM Eastern Daylight Time	Commonwealth Care Alliance Massachusetts, LLC.	Commonwealth Care Alliance Massachusetts	www.commonwealthcarealliance.org/become-a-member	CCA Medicare Preferred (PPO)	01	04		1			H9414	001	0	2023	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	5	1			2		0	08/05/2022	2023.01	08/05/2022 12:14:31 PM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time			08/05/2022 12:57:01 PM Eastern Daylight Time	Commonwealth Care Alliance Massachusetts, LLC.	Commonwealth Care Alliance Massachusetts	www.commonwealthcarealliance.org/become-a-member	CCA Medicare Value (PPO)	01	04		1			H9414	002	0	2023	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			
H9414	003	0	1	04	01	H9414_003_0	4	1			2		1	08/05/2022	2023.01	08/05/2022 12:19:47 PM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time			08/05/2022 12:57:01 PM Eastern Daylight Time	Commonwealth Care Alliance Massachusetts, LLC.	Commonwealth Care Alliance Massachusetts	www.commonwealthcarealliance.org/become-a-member	CCA Medicare Premier (PPO)	01	04		1			H9414	003	0	2023	MID, NOR, 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			
H9428	001	0	1	04	01	H9428_001_0	4	1						08/01/2022	2023.01	08/01/2022 12:47:30 PM Eastern Daylight Time	08/03/2022 09:40:30 PM Eastern Daylight Time	07/30/2022 10:49:53 AM Eastern Daylight Time			08/04/2022 05:23:51 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	2023	Select counties in TN		2		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	4	1						05/31/2022	2023.01	05/31/2022 10:08:05 AM Eastern Daylight Time	08/03/2022 09:39:01 PM Eastern Daylight Time	07/30/2022 10:50:26 AM Eastern Daylight Time			08/04/2022 05:23:51 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	2023	Select counties in TN		2		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	2	1						08/01/2022	2023.01	08/01/2022 06:23:34 PM Central Daylight Time	08/02/2022 02:11:54 PM Central Daylight Time	07/31/2022 11:54:04 PM Central Daylight Time			08/04/2022 04:16:39 PM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H9431	001	0	2023	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						08/10/2022	2023.01	08/10/2022 03:09:28 PM Eastern Daylight Time	08/02/2022 03:33:57 PM Eastern Daylight Time	08/01/2022 12:54:32 AM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	Bonner, Kootenai and Shoshone 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	004	0	1	04	01	H9431_004_0	3	1						08/10/2022	2023.01	08/10/2022 03:09:51 PM Eastern Daylight Time	08/02/2022 03:35:03 PM Eastern Daylight Time	08/01/2022 12:54:58 AM Eastern Daylight Time			08/10/2022 03:45:21 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	2023	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	2	1						08/02/2022	2023.01	08/02/2022 06:05:27 PM Eastern Daylight Time	08/02/2022 03:36:07 PM Eastern Daylight Time	08/01/2022 12:55:26 AM Eastern Daylight Time			08/04/2022 06:39:03 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	2023	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	2	1						08/02/2022	2023.01	08/02/2022 06:05:46 PM Eastern Daylight Time	08/02/2022 03:37:24 PM Eastern Daylight Time	08/01/2022 12:55:52 AM Eastern Daylight Time			08/04/2022 06:39:03 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	2023	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	013	0	1	04	01	H9431_013_0	3	1						08/01/2022	2023.01	08/01/2022 01:11:38 PM Central Daylight Time	08/02/2022 01:04:09 PM Central Daylight Time	07/31/2022 11:56:18 PM Central Daylight Time			08/04/2022 09:38:27 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	2023	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						08/01/2022	2023.01	08/01/2022 01:12:26 PM Central Daylight Time	08/02/2022 01:04:58 PM Central Daylight Time	07/31/2022 11:56:46 PM Central Daylight Time			08/04/2022 09:38:27 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	2023	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	1	1				0	0	05/31/2022	2023.01	05/31/2022 07:16:23 PM Eastern Daylight Time	06/01/2022 02:25:09 PM Eastern Daylight Time				06/02/2022 12:35:40 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	2023	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	1	1				0	0	05/31/2022	2023.01	05/31/2022 07:17:07 PM Eastern Daylight Time	06/01/2022 02:26:14 PM Eastern Daylight Time				06/02/2022 12:35:40 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	2023	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	2	1				0	0	05/31/2022	2023.01	05/31/2022 11:06:19 AM Central Daylight Time	08/02/2022 02:12:55 PM Central Daylight Time				08/05/2022 09:49:14 AM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H9431	017	0	2023	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	05/30/2022	2023.01	05/30/2022 06:11:12 PM Eastern Daylight Time					06/02/2022 03:45:58 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	2023	Multi-State		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H9431	802	0	1	04	01	H9431_802_0	1	1						05/31/2022	2023.01	05/31/2022 10:31:33 AM Eastern Daylight Time					06/02/2022 03:45:58 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	2023	Multi-State		1	120	2			2									www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H9438	001	0	1	20	08	H9438_001_0	3	1						06/02/2022	2023.01	06/02/2022 10:19:08 AM Central Daylight Time		06/02/2022 10:15:01 AM Central Daylight Time			06/02/2022 10:19:57 AM Central Daylight Time	BLUESTEM PACE, INC.	Bluestem PACE	www.bluestempace.org	Bluestem PACE (PACE)	08	20		1			H9438	001	0	2023	Counties:  RC, HV, RN, MN, MP, SA, EW, DK, OT, LC		2		2			2									NA	NA										(844)588-7223		(620)504-5900		(844)588-7223		(620)504-5674												(620)504-5900		(844)588-7223		(620)504-5674																
H9438	002	0	1	20	08	H9438_002_0	1	1						05/31/2022	2023.01	05/31/2022 12:17:33 PM Central Daylight Time		05/31/2022 11:56:45 AM Central Daylight Time			05/31/2022 12:24:04 PM Central Daylight Time	BLUESTEM PACE, INC.	Bluestem PACE	www.bluestempace.org	Bluestem PACE (PACE)	08	20		1			H9438	002	0	2023	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	6	1	2	1			0	08/04/2022	2023.01	08/04/2022 08:37:09 PM Mountain Daylight Time	08/05/2022 01:43:06 PM Mountain Daylight Time	08/05/2022 01:43:13 PM Mountain Daylight Time			08/05/2022 02:01:55 PM Mountain Daylight Time	HEALTH CHOICE UTAH, INC.	Health Choice Generations Utah	https://healthchoicegenerations.com	Health Choice Generations Utah (HMO D-SNP)	01	01		1			H9455	001	0	2023	Counties: Salt Lake, Utah, Davis, Weber, Tooele		2		2			1	3		2					2	https://healthchoicegenerations.com	https://healthchoicegenerations.com	https://healthchoicegenerations.com	(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(844)910-3484		(844)910-3484		(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	4	1						08/02/2022	2023.01	08/02/2022 05:54:19 PM Central Daylight Time	08/04/2022 08:23:09 AM Central Daylight Time	08/01/2022 12:16:18 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTHCARE OF ST LOUIS, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9460	001	0	2023	Kansas City		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)612-0287		(866)612-0287		(800)668-3813		(800)668-3813		(866)612-0287		(866)612-0287		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9469	001	0	1	04	01	H9469_001_0	6	1						08/01/2022	2023.01	08/01/2022 01:15:29 PM Eastern Daylight Time	08/04/2022 06:22:32 PM Eastern Daylight Time	08/04/2022 06:41:03 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Simply Healthcare	shop.simplyhealthcareplans.com/medicare	Simply Freedom (PPO)	01	04		1			H9469	001	0	2023	Broward, Dade, 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			
H9469	002	0	1	04	01	H9469_002_0	6	1						08/01/2022	2023.01	08/01/2022 01:16:02 PM Eastern Daylight Time	08/04/2022 06:22:34 PM Eastern Daylight Time	08/04/2022 06:41:06 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Simply Healthcare	shop.simplyhealthcareplans.com/medicare	Simply Freedom (PPO)	01	04		1			H9469	002	0	2023	Brevard, Indian River, Martin, St. Lucie		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			
H9469	003	0	1	04	01	H9469_003_0	8	1						08/01/2022	2023.01	08/01/2022 01:16:34 PM Eastern Daylight Time	08/04/2022 06:22:36 PM Eastern Daylight Time	08/04/2022 06:41:09 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Simply Healthcare	shop.simplyhealthcareplans.com/medicare	Simply Freedom (PPO)	01	04		1			H9469	003	0	2023	Clay, Duval, Flagler, Putnam, St. Johns		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			
H9469	004	0	1	04	01	H9469_004_0	6	1						06/02/2022	2023.01	06/02/2022 10:37:37 AM Eastern Daylight Time	08/04/2022 06:22:37 PM Eastern Daylight Time	08/04/2022 06:41:11 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Simply Healthcare	shop.simplyhealthcareplans.com/medicare	Simply Freedom Extra (PPO)	01	04		1			H9469	004	0	2023	Charlotte, Collier, Lee, Manatee, Sarasota		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			
H9469	005	0	1	04	01	H9469_005_0	6	1						06/02/2022	2023.01	06/02/2022 10:38:03 AM Eastern Daylight Time	08/04/2022 06:22:38 PM Eastern Daylight Time	08/04/2022 06:41:14 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Simply Healthcare	shop.simplyhealthcareplans.com/medicare	Simply Freedom Extra (PPO)	01	04		1			H9469	005	0	2023	Select counties in Tampa Area		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			
H9469	006	0	1	04	01	H9469_006_0	6	1						08/01/2022	2023.01	08/01/2022 01:17:11 PM Eastern Daylight Time	08/04/2022 06:22:40 PM Eastern Daylight Time	08/04/2022 06:41:17 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Simply Healthcare	shop.simplyhealthcareplans.com/medicare	Simply Freedom (PPO)	01	04		1			H9469	006	0	2023	Orange, Osceola, Seminole, Volusia		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			
H9469	007	0	1	04	01	H9469_007_0	6	1						08/01/2022	2023.01	08/01/2022 01:18:28 PM Eastern Daylight Time	08/04/2022 06:22:41 PM Eastern Daylight Time	08/04/2022 06:41:19 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Simply Healthcare	shop.simplyhealthcareplans.com/medicare	Simply Freedom (PPO)	01	04		1			H9469	007	0	2023	Charlotte, Collier, Lee, Manatee, Sarasota		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			
H9469	008	0	1	04	01	H9469_008_0	6	1						08/01/2022	2023.01	08/01/2022 01:19:13 PM Eastern Daylight Time	08/04/2022 06:22:43 PM Eastern Daylight Time	08/04/2022 06:41:22 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Simply Healthcare	shop.simplyhealthcareplans.com/medicare	Simply Freedom (PPO)	01	04		1			H9469	008	0	2023	Select counties in Tampa Area		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			
H9469	009	0	1	04	01	H9469_009_0	6	1						08/01/2022	2023.01	08/01/2022 01:19:45 PM Eastern Daylight Time	08/04/2022 06:22:44 PM Eastern Daylight Time	08/04/2022 06:41:25 PM Eastern Daylight Time			08/04/2022 07:22:32 PM Eastern Daylight Time	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Simply Healthcare	shop.simplyhealthcareplans.com/medicare	Simply Freedom (PPO)	01	04		1			H9469	009	0	2023	Lake, Marion, Sumter		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			
H9485	001	0	1	04	01	H9485_001_0	5	1						08/03/2022	2023.01	08/03/2022 01:25:46 PM Eastern Daylight Time	08/03/2022 02:52:37 PM Eastern Daylight Time	08/03/2022 03:31:15 PM Eastern Daylight Time			08/04/2022 04:19:05 PM Eastern Daylight Time	ALLWAYS HEALTH PARTNERS INC	AllWays Health Partners	www.allwayshealth.org	Mass General Brigham Advantage (PPO)	01	04		1			H9485	001	0	2023	Eastern Massachusetts		2		2			2									www.cvs.com	www.cvs.com	www.allwayshealth.org	(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9485	002	0	1	04	01	H9485_002_0	5	1						08/03/2022	2023.01	08/03/2022 01:29:54 PM Eastern Daylight Time	08/04/2022 02:26:22 PM Eastern Daylight Time	08/03/2022 03:34:11 PM Eastern Daylight Time			08/04/2022 04:19:05 PM Eastern Daylight Time	ALLWAYS HEALTH PARTNERS INC	AllWays Health Partners	www.allwayshealth.org	Mass General Brigham Advantage Premier (PPO)	01	04		1			H9485	002	0	2023	Eastern Massachusetts		2		2			2									www.cvs.com	www.cvs.com	www.allwayshealth.org	(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9485	801	0	1	04	01	H9485_801_0	2	1						06/02/2022	2023.01	06/02/2022 10:52:46 AM Eastern Daylight Time					06/03/2022 07:41:05 PM Eastern Daylight Time	ALLWAYS HEALTH PARTNERS INC	AllWays Health Partners	www.allwayshealth.org	Mass General Brigham Advantage Group PPO (PPO)	01	04		1			H9485	801	0	2023	Eastern Massachusetts		1	2400	2			2									www.cvs.com	www.cvs.com	www.allwayshealth.org	(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(866)414-5533		(857)282-3300		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		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;11a;11b;11c;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7f;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;	1									
H9489	001	0	1	01	01	H9489_001_0	10	1					1	08/05/2022	2023.01	08/05/2022 06:41:51 PM Eastern Daylight Time	08/08/2022 03:19:24 PM Eastern Daylight Time	08/05/2022 06:42:50 PM Eastern Daylight Time			08/08/2022 03:20:33 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	2023	State of Vermont		2		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		(855)207-5871		(855)207-5871		(855)207-5871		(855)207-5871		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9489	801	0	1	01	01	H9489_801_0	4	1						05/02/2022	2023.01	05/02/2022 01:33:09 PM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)207-5871		(855)207-5871		(855)207-5871		(855)207-5871		(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	4	1						05/02/2022	2023.01	05/02/2022 01:32:55 PM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)207-5871		(855)207-5871		(855)207-5871		(855)207-5871		(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	4	1						05/02/2022	2023.01	05/02/2022 01:32:42 PM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)207-5871		(855)207-5871		(855)207-5871		(855)207-5871		(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	4	1						05/02/2022	2023.01	05/02/2022 01:32:29 PM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)207-5871		(855)207-5871		(855)207-5871		(855)207-5871		(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	4	1						05/02/2022	2023.01	05/02/2022 01:32:17 PM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)207-5871		(855)207-5871		(855)207-5871		(855)207-5871		(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	4	1						05/02/2022	2023.01	05/02/2022 01:32:06 PM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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		(855)207-5871		(855)207-5871		(855)207-5871		(855)207-5871		(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	4	1				0	0	05/02/2022	2023.01	05/02/2022 01:31:53 PM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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					1				
H9489	808	0	1	02	01	H9489_808_0	4	1				0	0	05/02/2022	2023.01	05/02/2022 01:31:42 PM Eastern Daylight Time					06/06/2022 07:13:11 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	2023	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	1	1a;2;9a1;11a;15;	2		1				
H9525	003	0	1	01	01	H9525_003_0	5	1	2	1	1		0	06/02/2022	2023.01	06/02/2022 01:22:55 PM Venezuela Standard Time	08/04/2022 06:17:49 PM Venezuela Standard Time	08/04/2022 06:32:01 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard 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	2023	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	5	1			2		1	08/01/2022	2023.01	08/01/2022 03:23:05 PM Venezuela Standard Time	08/04/2022 06:17:51 PM Venezuela Standard Time	08/04/2022 06:32:04 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard 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	2023	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	5	1			2		1	08/01/2022	2023.01	08/01/2022 03:25:30 PM Venezuela Standard Time	08/04/2022 06:17:52 PM Venezuela Standard Time	08/04/2022 06:32:07 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard 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	2023	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	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 12:55:34 PM Eastern Daylight Time	08/04/2022 06:17:21 PM Eastern Daylight Time	08/04/2022 06:31:09 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	6	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 12:58:44 PM Eastern Daylight Time	08/04/2022 06:17:22 PM Eastern Daylight Time	08/04/2022 06:31:12 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	Select counties in KY		2		2			1	3		1					1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)681-2640		(833)681-2640		(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	7	1		1	2		0	08/01/2022	2023.01	08/01/2022 04:37:23 PM Eastern Daylight Time		08/04/2022 06:31:15 PM Eastern Daylight Time		08/04/2022 06:17:24 PM Eastern Daylight Time	08/19/2022 09:44:26 AM 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	2023	Kentucky		2		2			1	4			00000000100000000000000					https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)681-2640		(833)681-2640		(855)793-1933		(855)793-1933		(833)344-1015		(833)344-1015		(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	5	1	2	1	1		0	05/31/2022	2023.01	05/31/2022 04:08:22 PM Venezuela Standard Time	08/04/2022 06:17:54 PM Venezuela Standard Time	08/04/2022 06:32:09 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard 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	2023	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)344-1013		(833)344-1013		(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	5	1			2		1	08/01/2022	2023.01	08/01/2022 04:38:57 PM Eastern Daylight Time	08/04/2022 06:17:25 PM Eastern Daylight Time	08/04/2022 06:31:18 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	Select counties in KY	Rural KY	2		2			2									https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)558-1439		(855)558-1439		(855)793-1933		(855)793-1933		(833)344-1015		(833)344-1015		(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	5	1			2		1	08/01/2022	2023.01	08/01/2022 04:39:31 PM Eastern Daylight Time	08/04/2022 06:17:27 PM Eastern Daylight Time	08/04/2022 06:31:20 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	Select counties in KY	Louisville KY	2		2			2									https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)558-1439		(855)558-1439		(855)793-1933		(855)793-1933		(833)344-1015		(833)344-1015		(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	5	1			2		1	08/01/2022	2023.01	08/01/2022 04:40:11 PM Eastern Daylight Time	08/04/2022 06:17:28 PM Eastern Daylight Time	08/04/2022 06:31:23 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	Select counties in KY	Lexington KY	2		2			2									https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)558-1439		(855)558-1439		(855)793-1933		(855)793-1933		(833)344-1015		(833)344-1015		(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	5	1			2		1	08/01/2022	2023.01	08/01/2022 04:43:59 PM Eastern Daylight Time	08/04/2022 06:17:29 PM Eastern Daylight Time	08/04/2022 06:31:26 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	Select counties in KY	Cincinnati KY	2		2			2									https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)558-1439		(855)558-1439		(855)793-1933		(855)793-1933		(833)344-1015		(833)344-1015		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	015	0	1	01	01	H9525_015_0	5	1			2		1	08/01/2022	2023.01	08/01/2022 03:26:24 PM Venezuela Standard Time	08/04/2022 06:17:55 PM Venezuela Standard Time	08/04/2022 06:32:12 PM Venezuela Standard Time			08/04/2022 10:30:41 PM Venezuela Standard Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	015	0	2023	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	801	0	1	01	01	H9525_801_0	2	1						05/20/2022	2023.01	05/20/2022 09:13:43 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	802	0	1	01	01	H9525_802_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:14:10 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	Select counties in Wisconsin		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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	803	0	2	01	01	H9525_803_0	2	1						05/20/2022	2023.01	05/20/2022 09:14:33 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	804	0	1	01	01	H9525_804_0	2	1						05/20/2022	2023.01	05/20/2022 09:17:08 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	Kentucky - Select Counties		1	132	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	805	0	1	01	01	H9525_805_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:17:33 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	806	0	2	01	01	H9525_806_0	2	1						05/20/2022	2023.01	05/20/2022 09:18:45 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	807	0	2	01	01	H9525_807_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:19:17 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	809	0	1	01	01	H9525_809_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:25:14 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	811	0	2	01	01	H9525_811_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:25:38 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	813	0	1	01	01	H9525_813_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:26:09 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	815	0	2	01	01	H9525_815_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:26:43 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9525	816	0	2	01	01	H9525_816_0	2	1				0	0	05/20/2022	2023.01	05/20/2022 09:34:12 AM Pacific Daylight Time					06/03/2022 10:47:56 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	2023	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;10a;11a;11b;15;16b;18a;	2		1					1				
H9564	001	0	1	20	08	H9564_001_0	5	1						10/17/2022	2023.01	10/17/2022 05:14:34 PM Eastern Standard Time		10/17/2022 05:12:52 PM Eastern Standard Time			10/17/2022 05:18:29 PM Eastern Standard Time	PACE4DC LLC	PACE4DC LLC	www.PACE4DC.com	Pace4DC (PACE)	08	20		1			H9564	001	0	2023	Edenbridge Pace		2	120	1	1		2									www.carekinesis.com	www.carekinesis.com												(571)622-0555				(571)622-0555												(877)324-7223				(877)324-7223																
H9564	002	0	1	20	08	H9564_002_0	5	1						10/17/2022	2023.01	10/17/2022 05:14:57 PM Eastern Standard Time		10/17/2022 05:12:52 PM Eastern Standard Time			10/17/2022 05:18:29 PM Eastern Standard Time	PACE4DC LLC	PACE4DC LLC	www.PACE4DC.com	Pace4DC (PACE)	08	20		1			H9564	002	0	2023	Edenbridge Pace		2		1	1		2									www.carekinesis.com	www.carekinesis.com												(571)622-0555				(571)622-0555												(877)324-7223				(877)324-7223																
H9572	001	1	1	04	01	H9572_001_1	7	1						08/10/2022	2023.01	08/10/2022 11:28:02 AM Eastern Daylight Time	08/04/2022 01:25:14 PM Eastern Daylight Time	08/04/2022 01:25:15 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 1	2		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						08/04/2022	2023.01	08/04/2022 08:19:30 PM Eastern Daylight Time	08/04/2022 01:25:15 PM Eastern Daylight Time	08/04/2022 01:25:16 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 2	2		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						08/04/2022	2023.01	08/04/2022 08:19:17 PM Eastern Daylight Time	08/04/2022 01:25:16 PM Eastern Daylight Time	08/04/2022 01:25:16 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 3	2		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						08/04/2022	2023.01	08/04/2022 08:19:05 PM Eastern Daylight Time	08/04/2022 01:25:17 PM Eastern Daylight Time	08/04/2022 01:25:17 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 4	2		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						08/04/2022	2023.01	08/04/2022 08:18:52 PM Eastern Daylight Time	08/04/2022 01:25:17 PM Eastern Daylight Time	08/04/2022 01:25:18 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 6	2		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						08/04/2022	2023.01	08/04/2022 08:20:30 PM Eastern Daylight Time	08/04/2022 01:25:18 PM Eastern Daylight Time	08/04/2022 01:25:19 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 1	2		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						08/04/2022	2023.01	08/04/2022 08:21:49 PM Eastern Daylight Time	08/04/2022 01:25:19 PM Eastern Daylight Time	08/04/2022 01:25:19 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 2	2		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						08/04/2022	2023.01	08/04/2022 08:21:37 PM Eastern Daylight Time	08/04/2022 01:25:20 PM Eastern Daylight Time	08/04/2022 01:25:20 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 3	2		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						08/04/2022	2023.01	08/04/2022 08:21:25 PM Eastern Daylight Time	08/04/2022 01:25:21 PM Eastern Daylight Time	08/04/2022 01:25:21 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 4	2		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	8	1						08/04/2022	2023.01	08/04/2022 08:21:07 PM Eastern Daylight Time	08/04/2022 01:25:22 PM Eastern Daylight Time	08/04/2022 01:25:22 PM Eastern Daylight Time			08/10/2022 01:01:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	6	2023	State of Michigan	Region 6	2		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	8	1						08/04/2022	2023.01	08/04/2022 08:24:56 PM Eastern Daylight Time	08/04/2022 01:25:22 PM Eastern Daylight Time	08/04/2022 01:25:23 PM Eastern Daylight Time			08/10/2022 01:01:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	1	2023	State of Michigan	Region 1	2		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	8	1						08/04/2022	2023.01	08/04/2022 08:25:21 PM Eastern Daylight Time	08/04/2022 01:25:23 PM Eastern Daylight Time	08/04/2022 01:25:23 PM Eastern Daylight Time			08/10/2022 01:01:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	2	2023	State of Michigan	Region 2	2		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	8	1						08/04/2022	2023.01	08/04/2022 08:25:39 PM Eastern Daylight Time	08/04/2022 01:25:24 PM Eastern Daylight Time	08/04/2022 01:25:24 PM Eastern Daylight Time			08/10/2022 01:01:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	3	2023	State of Michigan	Region 3	2		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						08/04/2022	2023.01	08/04/2022 08:26:00 PM Eastern Daylight Time	08/04/2022 01:25:24 PM Eastern Daylight Time	08/04/2022 01:25:25 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 4	2		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						08/04/2022	2023.01	08/04/2022 08:26:20 PM Eastern Daylight Time	08/04/2022 01:25:25 PM Eastern Daylight Time	08/04/2022 01:25:25 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 6	2		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	7	1						08/04/2022	2023.01	08/04/2022 08:27:41 PM Eastern Daylight Time	08/04/2022 01:25:26 PM Eastern Daylight Time	08/04/2022 01:25:26 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 1	2		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	7	1						08/04/2022	2023.01	08/04/2022 08:29:01 PM Eastern Daylight Time	08/04/2022 01:24:54 PM Eastern Daylight Time	08/04/2022 01:24:54 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 2	2		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	7	1						08/04/2022	2023.01	08/04/2022 08:29:19 PM Eastern Daylight Time	08/04/2022 01:24:54 PM Eastern Daylight Time	08/04/2022 01:24:55 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 3	2		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	7	1						08/04/2022	2023.01	08/04/2022 08:29:37 PM Eastern Daylight Time	08/04/2022 01:24:55 PM Eastern Daylight Time	08/04/2022 01:24:55 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 4	2		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	7	1						08/04/2022	2023.01	08/04/2022 08:30:10 PM Eastern Daylight Time	08/04/2022 01:24:56 PM Eastern Daylight Time	08/04/2022 01:24:56 PM Eastern Daylight Time			08/10/2022 12:05:13 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	2023	State of Michigan	Region 6	2		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	3	1						05/11/2022	2023.01	05/11/2022 05:46:35 PM Eastern Daylight Time					06/06/2022 10:37:43 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	2023	State of Michigan		1	391029	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;5;6;7f;7g;8a;8b1;8b2;8b3;9a2;9b;9c;11a;11b;11c;15;	2		1									
H9572	802	0	1	04	01	H9572_802_0	3	1				0	0	05/11/2022	2023.01	05/11/2022 05:47:19 PM Eastern Daylight Time					06/06/2022 10:37:43 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer CY (PPO)	01	04		1			H9572	802	0	2023	State of Michigan		1	2815821	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;5;6;7f;7g;8a;8b1;8b2;8b3;9a1;9b;9c;11a;11b;11c;15;	2		1									
H9572	803	0	1	04	01	H9572_803_0	3	1						05/11/2022	2023.01	05/11/2022 05:47:38 PM Eastern Daylight Time					06/06/2022 10:37:43 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	2023	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;5;6;7f;7g;8a;8b1;8b2;8b3;9a1;9b;9c;11a;11b;11c;15;	2		1									
H9572	804	0	1	04	01	H9572_804_0	3	1				0	0	05/11/2022	2023.01	05/11/2022 05:47:58 PM Eastern Daylight Time					06/06/2022 10:37:43 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	2023	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;5;6;7f;7g;8a;8b1;8b2;8b3;9a1;9b;9c;11a;11b;11c;15;	2		1									
H9572	805	0	1	04	01	H9572_805_0	3	1				0	0	05/12/2022	2023.01	05/12/2022 10:39:19 PM Eastern Daylight Time					06/06/2022 10:37:43 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	2023	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;5;6;7f;7g;8a;8b1;8b2;8b3;9a1;9b;9c;11a;11b;11c;15;	2		1									
H9572	806	0	1	04	01	H9572_806_0	3	1						05/12/2022	2023.01	05/12/2022 10:38:35 PM Eastern Daylight Time					06/06/2022 10:37:43 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO UT (PPO)	01	04		1			H9572	806	0	2023	State of Michigan		1	1733353	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;5;6;7f;7g;8a;8b1;8b2;8b3;9a1;9b;9c;11a;11b;11c;15;	2		1									
H9576	001	0	1	48	05	H9576_001_0	3	1						03/17/2023	2023.01	03/17/2023 02:21:43 PM Eastern Daylight Time					03/17/2023 02:57:57 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	2023	State of Rhode Island		2	167587	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	10	1	2	1			0	08/05/2022	2023.01	08/05/2022 08:19:37 AM Eastern Daylight Time	08/03/2022 05:03:38 PM Eastern Daylight Time	08/03/2022 05:09:50 PM Eastern Daylight Time			08/05/2022 01:37:05 PM Eastern Daylight Time	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	WellSense Health Plan	wellsense.org/sco	WellSense Senior Care Options (HMO D-SNP)	01	01		1			H9585	001	0	2023	Barnstable, Bristol, Hampden, Plymouth, Suffolk		2		2			1	3		1					1	wellsense.org/members/ma/senior-care-options/prescriptions	wellsense.org/members/ma/senior-care-options/prescriptions/drug-list	wellsense.org/members/ma/senior-care-options#find-a-provider	(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	5	1					1	08/03/2022	2023.01	08/03/2022 08:07:46 AM Central Daylight Time	08/04/2022 03:26:33 PM Central Daylight Time	08/04/2022 03:35:53 PM Central Daylight Time			08/04/2022 04:25:51 PM Central Daylight Time	CLEAR SPRING HEALTH (GA), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Choice Plan (PPO)	01	04		1			H9589	003	0	2023	Select Georgia 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			
H9590	001	0	1	01	01	H9590_001_0	5	1		1				08/03/2022	2023.01	08/03/2022 09:07:40 AM Central Daylight Time	08/02/2022 11:24:43 AM Central Daylight Time	08/02/2022 10:54:00 AM Central Daylight Time			08/04/2022 02:26:49 PM 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	2023	Illinois (partial)		2		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						05/26/2022	2023.01	05/26/2022 03:59:29 PM Pacific Daylight Time		05/26/2022 10:52:31 AM Pacific Daylight Time			05/26/2022 04:03:40 PM Pacific Daylight Time	INNOVATIVE INTEGRATED HEALTH, INC.	Innovative Integrated Health Inc.	www.fresnopace.org	Innovative Integrated Health (PACE)	08	20		1			H9592	001	0	2023	Fresno, Kern, Madera, Orange, 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						05/26/2022	2023.01	05/26/2022 04:00:02 PM Pacific Daylight Time		05/26/2022 10:53:01 AM Pacific Daylight Time			05/26/2022 04:03:40 PM 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	2023	Fresno, Kern, Madera, Orange, 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	5	1						08/05/2022	2023.01	08/05/2022 02:45:39 PM Pacific Daylight Time	08/05/2022 02:17:25 PM Pacific Daylight Time	08/02/2022 11:01:36 AM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health AVA (PPO)	01	04		1			H9614	001	0	2023	Maricopa, Pima, Santa Cruz, El Paso & Hudspeth		2		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			
H9614	801	0	1	04	01	H9614_801_0	3	1						07/09/2022	2023.01	07/09/2022 10:00:50 AM Pacific Daylight Time					07/12/2022 04:15:18 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	2023	Maricopa, Pima, Santa Cruz, El Paso & Hudspeth		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			
H9614	802	0	1	04	01	H9614_802_0	3	1						07/09/2022	2023.01	07/09/2022 10:01:01 AM Pacific Daylight Time					07/12/2022 04:15:18 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	2023	Maricopa, Pima, Santa Cruz, El Paso & Hudspeth		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			
H9614	803	0	1	04	01	H9614_803_0	3	1				0	0	07/09/2022	2023.01	07/09/2022 10:01:12 AM Pacific Daylight Time					07/12/2022 04:15:18 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	2023	Maricopa, Pima, Santa Cruz, El Paso & Hudspeth		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			
H9614	804	0	1	04	01	H9614_804_0	3	1				0	0	07/09/2022	2023.01	07/09/2022 10:01:28 AM Pacific Daylight Time					07/12/2022 04:15:18 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	2023	Maricopa, Pima, Santa Cruz, El Paso & Hudspeth		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			
H9615	007	0	1	04	01	H9615_007_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:24:58 PM Eastern Daylight Time	08/04/2022 12:00:52 PM Eastern Daylight Time	08/05/2022 12:48:08 PM Eastern Daylight Time			08/05/2022 03:47:24 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	2023	S.Tier NY, Central NY, Eastern 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	008	0	1	04	01	H9615_008_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:31:00 PM Eastern Daylight Time	08/04/2022 12:01:14 PM Eastern Daylight Time	08/03/2022 03:20:50 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	S.Tier NY, Central NY, Eastern 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	009	0	1	04	01	H9615_009_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:33:24 PM Eastern Daylight Time	08/04/2022 12:01:44 PM Eastern Daylight Time	08/03/2022 03:21:08 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	Hudson Valley 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	010	0	1	04	01	H9615_010_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:36:29 PM Eastern Daylight Time	08/04/2022 12:02:22 PM Eastern Daylight Time	08/03/2022 03:21:26 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	Hudson Valley 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	012	0	1	04	01	H9615_012_0	8	1					1	08/03/2022	2023.01	08/03/2022 01:47:43 PM Eastern Daylight Time	08/04/2022 12:03:44 PM Eastern Daylight Time	08/03/2022 03:21:46 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	Western NY (Rochester/Buffalo)		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	014	0	1	04	01	H9615_014_0	8	1					1	08/03/2022	2023.01	08/03/2022 03:53:16 PM Eastern Daylight Time	08/04/2022 12:05:08 PM Eastern Daylight Time	08/03/2022 03:22:04 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	Western NY (Rochester/Buffalo)		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	9	1					1	08/03/2022	2023.01	08/03/2022 03:56:48 PM Eastern Daylight Time	08/04/2022 12:06:26 PM Eastern Daylight Time	08/05/2022 12:52:28 PM Eastern Daylight Time			08/05/2022 03:47:24 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	2023	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	9	1					1	08/03/2022	2023.01	08/03/2022 03:58:54 PM Eastern Daylight Time	08/04/2022 12:07:40 PM Eastern Daylight Time	08/03/2022 03:22:38 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	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	9	1					1	08/03/2022	2023.01	08/03/2022 04:01:04 PM Eastern Daylight Time	08/04/2022 12:08:34 PM Eastern Daylight Time	08/03/2022 03:22:56 PM Eastern Daylight Time			08/05/2022 04:15:16 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	2023	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	018	0	1	04	01	H9615_018_0	7	1					1	08/03/2022	2023.01	08/03/2022 04:03:19 PM Eastern Daylight Time	08/05/2022 01:13:44 PM Eastern Daylight Time	08/03/2022 03:23:14 PM Eastern Daylight Time			08/05/2022 03:47:24 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	018	0	2023	S.Tier NY, Central NY, Eastern 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	4	1						05/18/2022	2023.01	05/18/2022 05:04:25 PM Eastern Daylight Time					06/06/2022 02:21:56 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	2023	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		(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	4	1						05/18/2022	2023.01	05/18/2022 05:05:30 PM Eastern Daylight Time					06/06/2022 02:21:56 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	2023	United States and Puerto Rico		1	105672	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	4	1				0	0	05/18/2022	2023.01	05/18/2022 05:06:11 PM Eastern Daylight Time					06/06/2022 02:21:56 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	2023	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	4	1				0	0	05/11/2022	2023.01	05/11/2022 11:20:06 AM Eastern Daylight Time					06/06/2022 02:21:56 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	2023	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						05/25/2022	2023.01	05/25/2022 12:40:04 PM Pacific Daylight Time		05/25/2022 12:27:34 PM Pacific Daylight Time			05/25/2022 12:42:47 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	2023	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						05/25/2022	2023.01	05/25/2022 12:40:35 PM Pacific Daylight Time		05/25/2022 12:28:20 PM Pacific Daylight Time			05/25/2022 12:42:47 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	2023	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	002	0	1	01	01	H9630_002_0	5	1						08/01/2022	2023.01	08/01/2022 11:55:09 AM Eastern Daylight Time	08/03/2022 09:25:08 PM Eastern Daylight Time	07/30/2022 10:50:57 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		2			2									www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	003	0	1	01	01	H9630_003_0	5	1						08/01/2022	2023.01	08/01/2022 12:00:09 PM Eastern Daylight Time	08/03/2022 09:26:22 PM Eastern Daylight Time	07/30/2022 10:51:29 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		2			2									www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	005	0	1	01	01	H9630_005_0	5	1						06/01/2022	2023.01	06/01/2022 05:15:59 PM Eastern Daylight Time	08/03/2022 09:27:38 PM Eastern Daylight Time	07/30/2022 10:52:02 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		2			2									www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	008	0	1	01	01	H9630_008_0	5	1						08/01/2022	2023.01	08/01/2022 12:02:21 PM Eastern Daylight Time	08/03/2022 09:28:50 PM Eastern Daylight Time	07/30/2022 10:52:33 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		2			2									www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(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	05/25/2022	2023.01	05/25/2022 08:37:05 PM Eastern Daylight Time	06/03/2022 08:21:03 PM Eastern Daylight Time				07/15/2022 04:34:34 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	2023	Select counties in AR		2		2			2									www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9630	010	0	1	01	01	H9630_010_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:15:46 PM Eastern Daylight Time	08/03/2022 09:30:04 PM Eastern Daylight Time	07/30/2022 10:53:06 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		2			1	3		1					1	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	011	0	1	01	01	H9630_011_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:22:36 PM Eastern Daylight Time	08/03/2022 09:31:18 PM Eastern Daylight Time	07/30/2022 10:53:39 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in AR		2		2			1	3		1					1	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	013	0	1	01	01	H9630_013_0	5	1						08/01/2022	2023.01	08/01/2022 12:21:26 PM Eastern Daylight Time	08/03/2022 09:32:43 PM Eastern Daylight Time	07/30/2022 10:54:10 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare Low Premium (HMO)	01	01		1			H9630	013	0	2023	Select counties in AR		2		2			2									www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	801	0	1	01	01	H9630_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:20:36 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	Arkansas		1	100	2			2									allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:20:42 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	Arkansas		1	100	2			2									allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:20:47 AM Eastern Daylight Time					06/04/2022 08:15:06 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	2023	Arkansas		1	100	2			2									allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(855)565-9518		(855)565-9518		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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						06/01/2022	2023.01	06/01/2022 12:45:52 PM Mountain Daylight Time		05/27/2022 01:10:48 PM Mountain Daylight Time			06/01/2022 12:49:47 PM Mountain Daylight Time	HOPEWEST	HopeWest PACE	https://www.hopewestco.org/	Hope West PACE - Dual Eligible (PACE)	08	20		1			H9649	001	0	2023	Mesa County		2		2			2									https://www.hopewestco.org/	NA										(866)310-8900		(970)255-7223		(866)310-8900		(970)255-7223										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656																
H9649	002	0	1	20	08	H9649_002_0	1	1						06/01/2022	2023.01	06/01/2022 12:46:28 PM Mountain Daylight Time		05/27/2022 01:10:48 PM Mountain Daylight Time			06/01/2022 12:49:47 PM Mountain Daylight Time	HOPEWEST	HopeWest PACE	https://www.hopewestco.org/	Hope West Pace - Medicare Only (PACE)	08	20		1			H9649	002	0	2023	Mesa County		2		2			2									https://www.hopewestco.org/	NA										(866)310-8900		(970)255-7223		(866)310-8900		(970)255-7223										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656																
H9662	801	0	1	01	01	H9662_801_0	2	1						05/22/2022	2023.01	05/22/2022 05:44:03 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9662	801	0	2023	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						05/22/2022	2023.01	05/22/2022 05:44:42 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare FY (HMO)	01	01		1			H9662	802	0	2023	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				
H9678	001	0	1	04	01	H9678_001_0	10	1					1	08/05/2022	2023.01	08/05/2022 01:21:59 PM Eastern Daylight Time	08/04/2022 08:47:58 PM Eastern Daylight Time	08/04/2022 05:38:22 PM Eastern Daylight Time			08/05/2022 02:53:32 PM Eastern Daylight Time	HEALTHFIRST INSURANCE COMPANY, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Signature (PPO)	01	04		1			H9678	001	0	2023	New York City and Nassau County		2		2			2									www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org	(833)350-2910		(833)350-2910		(877)237-1303		(877)237-1303		(833)350-2910		(833)350-2910		(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			
H9686	001	0	1	01	01	H9686_001_0	4	1					0	08/05/2022	2023.01	08/05/2022 02:46:09 PM Pacific Daylight Time	08/05/2022 02:17:29 PM Pacific Daylight Time	08/02/2022 10:54:38 AM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Platinum (HMO)	01	01		1			H9686	001	0	2023	Clark, Washoe, Nye, Storey, Douglas & Carson City		2		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	08/05/2022	2023.01	08/05/2022 02:46:40 PM Pacific Daylight Time	08/05/2022 02:17:31 PM Pacific Daylight Time	08/02/2022 10:55:56 AM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health AVA (HMO)	01	01		1			H9686	003	0	2023	Clark, Washoe, Nye, Storey, Douglas & Carson City		2		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	5	1		1			1	08/05/2022	2023.01	08/05/2022 02:46:58 PM Pacific Daylight Time	08/05/2022 02:17:18 PM Pacific Daylight Time	08/02/2022 02:28:54 PM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Heart & Diabetes (HMO C-SNP)	01	01		1			H9686	004	0	2023	Clark, Washoe, Nye, Storey, Douglas & Carson City		2		2			1	4			00000000000000000010000					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	3	1	2	1			0	07/11/2022	2023.01	07/11/2022 10:20:54 AM Pacific Daylight Time	08/05/2022 02:17:19 PM Pacific Daylight Time	08/02/2022 11:04:14 AM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health the ONE (HMO D-SNP)	01	01		1			H9686	005	0	2023	Clark, Washoe, Nye, Storey, Douglas & Carson City		2		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	2	1						06/01/2022	2023.01	06/01/2022 08:06:56 PM Pacific Daylight Time					06/06/2022 05:39:53 PM 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	2023	Clark, Washoe, Nye, Storey, Douglas & Carson City		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	2	1						06/03/2022	2023.01	06/03/2022 12:11:14 PM Pacific Daylight Time					06/06/2022 05:39:53 PM 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	2023	Clark, Washoe, Nye, Storey, Douglas & Carson City		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	2	1				0	0	06/03/2022	2023.01	06/03/2022 12:11:54 PM Pacific Daylight Time					06/06/2022 05:39:53 PM 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	2023	Clark, Washoe, Nye, Storey, Douglas & Carson City		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	3	1				0	0	06/03/2022	2023.01	06/03/2022 12:14:12 PM Pacific Daylight Time					06/06/2022 05:52:06 PM 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	2023	Clark, Washoe, Nye, Storey, Douglas & Carson City		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	3	1						08/03/2022	2023.01	08/03/2022 08:08:35 AM Central Daylight Time	08/04/2022 01:08:58 PM Central Daylight Time	08/04/2022 01:09:03 PM Central Daylight Time			08/04/2022 01:42:16 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Health Advantage Blue Classic (HMO)	01	01		1			H9699	004	1	2023	State of Arkansas	Northwest and West Central AR counties	2		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	3	1						08/03/2022	2023.01	08/03/2022 08:09:54 AM Central Daylight Time	08/04/2022 01:09:09 PM Central Daylight Time	08/04/2022 01:09:14 PM Central Daylight Time			08/04/2022 01:42:16 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Health Advantage Blue Classic (HMO)	01	01		1			H9699	004	2	2023	State of Arkansas	East Central AR counties	2		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	3	1						08/03/2022	2023.01	08/03/2022 08:10:18 AM Central Daylight Time	08/04/2022 01:09:20 PM Central Daylight Time	08/04/2022 01:09:26 PM Central Daylight Time			08/04/2022 01:42:16 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Health Advantage Blue Classic (HMO)	01	01		1			H9699	004	3	2023	State of Arkansas	Central AR counties	2		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	3	1					1	08/03/2022	2023.01	08/03/2022 08:10:45 AM Central Daylight Time	08/04/2022 01:09:31 PM Central Daylight Time	08/04/2022 01:09:36 PM Central Daylight Time			08/04/2022 01:42:16 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Health Advantage Blue Premier (HMO)	01	01		1			H9699	006	0	2023	Select Counties in West and Central AR		2		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	7	1						08/03/2022	2023.01	08/03/2022 11:40:05 AM Central Daylight Time	08/05/2022 02:14:51 PM Central Daylight Time	08/03/2022 07:06:29 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H9706	001	0	2023	Dallas Metro Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	002	0	1	01	01	H9706_002_0	7	1	2	1			0	07/05/2022	2023.01	07/05/2022 12:04:57 PM Central Daylight Time	06/05/2022 10:11:04 AM Central Daylight Time	06/06/2022 04:01:07 PM Central Daylight Time			07/13/2022 02:06:55 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/dsnp	Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)	01	01		1			H9706	002	0	2023	Texas		2		2			1	3		1					2	getbluetx.com/dsnp/pharmacies	getbluetx.com/dsnp/druglist	getbluetx.com/dsnp/providers	(877)895-6437		(877)895-6437		(877)583-8129		(877)583-8129		(877)895-6437		(877)895-6437		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	003	0	1	01	01	H9706_003_0	7	1						08/03/2022	2023.01	08/03/2022 11:40:46 AM Central Daylight Time	08/05/2022 02:18:06 PM Central Daylight Time	08/03/2022 07:09:09 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H9706	003	0	2023	Austin Metro		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	005	0	1	01	01	H9706_005_0	7	1						08/03/2022	2023.01	08/03/2022 11:41:16 AM Central Daylight Time	08/05/2022 02:19:28 PM Central Daylight Time	08/03/2022 07:10:28 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H9706	005	0	2023	Houston Market		2		2			2									getbluetx.com/mapd	getbluetx.com/mapd	getbluetx.com/mapd	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	006	0	1	01	01	H9706_006_0	7	1						08/03/2022	2023.01	08/03/2022 11:41:43 AM Central Daylight Time	08/05/2022 02:20:41 PM Central Daylight Time	08/03/2022 07:11:48 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H9706	006	0	2023	West Texas		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	007	0	1	01	01	H9706_007_0	7	1						08/04/2022	2023.01	08/04/2022 02:27:14 PM Central Daylight Time	08/05/2022 02:22:15 PM Central Daylight Time	08/03/2022 07:13:07 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Dental Value (HMO)	01	01		1			H9706	007	0	2023	Texas		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	008	0	1	01	01	H9706_008_0	7	1						08/04/2022	2023.01	08/04/2022 02:27:40 PM Central Daylight Time	08/05/2022 02:23:58 PM Central Daylight Time	08/03/2022 07:14:27 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Saver (HMO)	01	01		1			H9706	008	0	2023	Texas		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	009	0	1	01	01	H9706_009_0	6	1						08/03/2022	2023.01	08/03/2022 11:46:05 AM Central Daylight Time	08/05/2022 02:25:13 PM Central Daylight Time	08/03/2022 07:15:46 PM Central Daylight Time			08/05/2022 06:52:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H9706	009	0	2023	San Antonio Market		2		2			2									getbluetx.com/mapd/pharmacies	getbluetx.com/mapd/druglist	getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	801	0	1	01	01	H9706_801_0	3	1						06/02/2022	2023.01	06/02/2022 08:43:23 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	802	0	1	01	01	H9706_802_0	3	1						06/02/2022	2023.01	06/02/2022 08:43:14 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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)213-1817		(877)213-1817		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	803	0	1	01	01	H9706_803_0	3	1				0	0	06/02/2022	2023.01	06/02/2022 08:42:59 AM Central Daylight Time					06/06/2022 08:35:13 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	2023	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	11	1						05/31/2023	2023.01	05/31/2023 09:48:56 AM Eastern Daylight Time					05/31/2023 09:49:16 AM 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	2023	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	003	0	1	01	01	H9725_003_0	4	1	2	1	1		0	05/24/2022	2023.01	05/24/2022 06:37:06 AM Central Daylight Time	08/02/2022 12:24:13 PM Central Daylight Time	08/01/2022 12:16:50 PM Central Daylight Time			08/04/2022 03:55:27 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	2023	North Carolina		2		2			1	3		2					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	005	0	1	01	01	H9725_005_0	2	1			2	0	0	05/15/2022	2023.01	05/15/2022 09:22:08 AM Central Daylight Time	05/31/2022 09:42:32 AM Central Daylight Time				06/02/2022 11:05:04 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Courage Medicare (HMO)	01	01		1			H9725	005	0	2023	North Carolina		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9725	006	0	1	01	01	H9725_006_0	4	1			2		1	05/31/2022	2023.01	05/31/2022 07:14:53 PM Central Daylight Time	08/02/2022 12:25:02 PM Central Daylight Time	08/01/2022 12:17:22 PM Central Daylight Time			08/04/2022 03:55:27 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	2023	North Carolina		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	008	0	1	01	01	H9725_008_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 08:50:31 PM Central Daylight Time	08/02/2022 01:12:35 PM Central Daylight Time	08/01/2022 12:17:53 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9725	008	0	2023	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	2			
H9725	009	1	1	01	01	H9725_009_1	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:50:02 PM Central Daylight Time	08/02/2022 12:25:31 PM Central Daylight Time	08/01/2022 12:18:25 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9725	009	1	2023	North Carolina	NC Preferred	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	009	2	1	01	01	H9725_009_2	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:50:15 PM Central Daylight Time	08/02/2022 12:26:10 PM Central Daylight Time	08/01/2022 12:18:56 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9725	009	2	2023	North Carolina	NC Preferred Select	2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	010	0	1	01	01	H9725_010_0	5	1			2		1	08/02/2022	2023.01	08/02/2022 05:58:00 PM Central Daylight Time	08/02/2022 04:19:52 PM Central Daylight Time	08/01/2022 12:19:27 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9725	010	0	2023	Richmond		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	011	0	1	01	01	H9725_011_0	4	1			2		1	06/01/2022	2023.01	06/01/2022 06:32:40 PM Central Daylight Time	08/02/2022 04:20:43 PM Central Daylight Time	08/01/2022 12:19:58 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H9725	011	0	2023	Richmond		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	012	0	1	01	01	H9725_012_0	5	1			2		1	08/02/2022	2023.01	08/02/2022 04:51:10 PM Central Daylight Time	08/02/2022 12:26:42 PM Central Daylight Time	08/01/2022 12:20:29 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H9725	012	0	2023	Asheville/Charlotte/Triad/Triangle		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	013	0	1	01	01	H9725_013_0	4	1	2	1	1		0	05/29/2022	2023.01	05/29/2022 03:44:33 PM Central Daylight Time	08/02/2022 12:27:11 PM Central Daylight Time	08/01/2022 12:21:02 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H9725	013	0	2023	North Carolina		2		2			1	3		1					2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	014	0	1	01	01	H9725_014_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 04:51:34 PM Central Daylight Time	08/02/2022 12:27:41 PM Central Daylight Time	08/01/2022 12:21:34 PM Central Daylight Time			08/04/2022 03:55:27 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Select Medicare (HMO)	01	01		1			H9725	014	0	2023	Charlotte/Triangle/Triad		2		2			2									www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	801	0	1	01	01	H9725_801_0	2	1						05/22/2022	2023.01	05/22/2022 05:43:14 PM Central Daylight Time					06/02/2022 11:05:04 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9725	801	0	2023	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;	1					1				
H9730	003	0	1	01	01	H9730_003_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 02:13:45 PM Eastern Daylight Time	08/03/2022 08:29:50 PM Eastern Daylight Time	07/30/2022 10:54:43 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	All counties in KY		2		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	1		0	07/05/2022	2023.01	07/05/2022 02:20:08 PM Eastern Daylight Time	08/03/2022 08:31:03 PM Eastern Daylight Time	07/30/2022 10:55:16 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	All counties in KY		2		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						08/01/2022	2023.01	08/01/2022 03:42:47 PM Eastern Daylight Time	08/03/2022 08:32:14 PM Eastern Daylight Time	07/30/2022 10:55:48 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	All counties in KY		2		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						08/01/2022	2023.01	08/01/2022 03:49:36 PM Eastern Daylight Time	08/03/2022 08:33:26 PM Eastern Daylight Time	07/30/2022 10:56:19 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	All counties in KY		2		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						08/01/2022	2023.01	08/01/2022 03:55:18 PM Eastern Daylight Time	08/03/2022 08:34:39 PM Eastern Daylight Time	07/30/2022 10:56:51 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	All counties in KY		2		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						06/01/2022	2023.01	06/01/2022 05:01:08 PM Eastern Daylight Time	08/03/2022 08:35:53 PM Eastern Daylight Time	07/30/2022 10:57:22 AM Eastern Daylight Time			08/04/2022 05:38:39 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	2023	All counties in KY		2		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	4	1						08/03/2022	2023.01	08/03/2022 02:15:39 PM Eastern Daylight Time	08/03/2022 07:37:03 PM Central Daylight Time	07/30/2022 09:57:55 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H9761	001	0	2023	Select counties in MA		2		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	4	1						08/01/2022	2023.01	08/01/2022 03:16:27 PM Eastern Daylight Time	08/03/2022 07:38:16 PM Central Daylight Time	07/30/2022 09:58:27 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H9761	002	0	2023	Select counties in MA		2		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						08/01/2022	2023.01	08/01/2022 03:21:32 PM Eastern Daylight Time	08/03/2022 07:39:25 PM Central Daylight Time	07/30/2022 09:58:59 AM Central Daylight Time			08/04/2022 04:08:52 PM Central Daylight Time	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced Open (PPO)	01	04		1			H9761	004	0	2023	Select counties in MA		2		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	002	0	1	02	01	H9763_002_0	6	1					1	08/02/2022	2023.01	08/02/2022 01:11:14 PM Central Daylight Time	08/04/2022 01:04:00 PM Central Daylight Time	08/04/2022 10:14:03 AM Central Daylight Time			08/05/2022 03:10:10 PM Central Daylight Time	OCHSNER HEALTH PLAN, INC.	Ochsner Health Plan	ochsnerhealthplan.com	Ochsner Health Plan Freedom (HMO-POS)	01	02		1			H9763	002	0	2023	New Orleans and Baton Rouge Areas		2		2			2									ochsnerhealthplan.com	ochsnerhealthplan.com	ochsnerhealthplan.com	(833)674-2112		(504)354-3655		(855)431-3377		(504)354-3655		(833)674-2112		(504)354-3655		(855)431-3377		(504)354-3655		(800)833-5833		(711)-		(800)833-5833		(711)-		(800)833-5833		(711)-		(800)833-5833		(711)-		2					2					2	2			
H9763	003	1	1	01	01	H9763_003_1	6	1					1	08/02/2022	2023.01	08/02/2022 01:11:45 PM Central Daylight Time	08/04/2022 10:22:58 AM Central Daylight Time	08/04/2022 10:13:25 AM Central Daylight Time			08/05/2022 03:10:10 PM Central Daylight Time	OCHSNER HEALTH PLAN, INC.	Ochsner Health Plan	ochsnerhealthplan.com	Ochsner Health Plan Premier (HMO)	01	01		1			H9763	003	1	2023	New Orleans and Baton Rouge Areas	New Orleans Southshore and Baton Rouge Area	2		2			2									ochsnerhealthplan.com	ochsnerhealthplan.com	ochsnerhealthplan.com	(833)674-2112		(504)354-3655		(855)431-3377		(504)354-3655		(833)674-2112		(504)354-3655		(855)431-3377		(504)354-3655		(800)833-5833		(711)-		(800)833-5833		(711)-		(800)833-5833		(711)-		(800)833-5833		(711)-		2					2					2	2			
H9763	003	2	1	01	01	H9763_003_2	6	1					1	08/02/2022	2023.01	08/02/2022 01:12:18 PM Central Daylight Time	08/04/2022 10:24:43 AM Central Daylight Time	08/04/2022 10:14:59 AM Central Daylight Time			08/05/2022 03:10:10 PM Central Daylight Time	OCHSNER HEALTH PLAN, INC.	Ochsner Health Plan	ochsnerhealthplan.com	Ochsner Health Plan Premier (HMO)	01	01		1			H9763	003	2	2023	New Orleans and Baton Rouge Areas	St. Tammany Parish	2		2			2									ochsnerhealthplan.com	ochsnerhealthplan.com	ochsnerhealthplan.com	(833)674-2112		(504)354-3655		(855)431-3377		(504)354-3655		(833)674-2112		(504)354-3655		(855)431-3377		(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	7	1						08/09/2022	2023.01	08/09/2022 08:41:24 PM India Standard Time	08/04/2022 01:17:05 PM Central Daylight Time	08/01/2022 12:38:16 PM Central Daylight Time			08/10/2022 09:45:08 AM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.htanc.com	HealthTeam Advantage Plan I (PPO)	01	04		1			H9808	004	0	2023	Piedmont Triad		2		2			2									www.htanc.com	www.htanc.com	www.htanc.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	7	1						08/09/2022	2023.01	08/09/2022 08:42:04 PM India Standard Time	08/04/2022 01:19:55 PM Central Daylight Time	08/04/2022 02:04:08 PM Central Daylight Time			08/10/2022 09:45:08 AM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.htanc.com	HealthTeam Advantage Plan II (PPO)	01	04		1			H9808	005	0	2023	Piedmont Triad		2		2			2									www.htanc.com	www.htanc.com	www.htanc.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	3	1						07/25/2022	2023.01	07/25/2022 09:19:22 PM India Standard Time					07/25/2022 12:49:41 PM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.htanc.com	HealthTeam Advantage Plan I EGWP (PPO)	01	04		1			H9808	807	0	2023	Piedmont Triad		1	1200	2			2									www.htanc.com	www.htanc.com	www.htanc.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	3	1						07/25/2022	2023.01	07/25/2022 09:16:16 PM India Standard Time					07/25/2022 12:49:41 PM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.htanc.com	HealthTeam Advantage Plan II EGWP (PPO)	01	04		1			H9808	808	0	2023	Piedmont Triad		1	1200	2			2									www.htanc.com	www.htanc.com	www.htanc.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						08/01/2022	2023.01	08/01/2022 12:58:59 PM Eastern Daylight Time	08/03/2022 09:33:58 PM Eastern Daylight Time	07/30/2022 10:59:30 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in MS		2		2			2									www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(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	1		0	07/05/2022	2023.01	07/05/2022 12:26:13 PM Eastern Daylight Time	08/03/2022 09:35:15 PM Eastern Daylight Time	07/30/2022 11:00:03 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in MS		2		2			1	3		1					1	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	(833)260-4124		(833)260-4124		(844)917-0175		(844)917-0175		(833)260-4124		(833)260-4124		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	008	0	1	01	01	H9811_008_0	5	1						08/03/2022	2023.01	08/03/2022 03:47:55 PM Eastern Daylight Time	08/03/2022 09:36:27 PM Eastern Daylight Time	07/30/2022 11:00:35 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in MS		2		2			2									www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	009	0	1	01	01	H9811_009_0	5	1						05/28/2022	2023.01	05/28/2022 08:43:21 PM Eastern Daylight Time	08/03/2022 09:37:39 PM Eastern Daylight Time	07/30/2022 11:01:09 AM Eastern Daylight Time			08/04/2022 05:27:42 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	2023	Select counties in MS		2		2			2									www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	801	0	1	01	01	H9811_801_0	1	1						05/10/2022	2023.01	05/10/2022 11:20:54 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	01	01		1			H9811	801	0	2023	Statewide		1	100	2			2									allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1				0	0	05/10/2022	2023.01	05/10/2022 11:20:59 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	01	01		1			H9811	802	0	2023	Statewide		1	100	2			2									allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	1	1						05/10/2022	2023.01	05/10/2022 11:21:03 AM Eastern Daylight Time					06/04/2022 08:15:06 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	01	01		1			H9811	803	0	2023	Statewide		1	100	2			2									allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(844)786-7711		(844)786-7711		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;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	002	1	1	01	01	H9826_002_1	9	1	2	1			0	08/05/2022	2023.01	08/05/2022 08:22:37 AM Central Daylight Time	08/04/2022 12:37:31 PM Central Daylight Time	08/04/2022 10:11:08 AM Central Daylight Time			08/05/2022 08:25:01 AM 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	002	1	2023	Southeast Texas	Southeast Texas: Segment 001	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			
H9826	002	2	1	01	01	H9826_002_2	9	1	2	1			0	08/05/2022	2023.01	08/05/2022 08:22:49 AM Central Daylight Time	08/04/2022 12:38:39 PM Central Daylight Time	08/04/2022 10:17:44 AM Central Daylight Time			08/05/2022 08:25:01 AM 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	002	2	2023	Southeast Texas	Southeast Texas: Segment 002	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			
H9826	002	3	1	01	01	H9826_002_3	9	1	2	1			0	08/05/2022	2023.01	08/05/2022 08:23:05 AM Central Daylight Time	08/04/2022 12:39:45 PM Central Daylight Time	08/04/2022 10:18:43 AM Central Daylight Time			08/05/2022 08:25:01 AM 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	002	3	2023	Southeast Texas	Southeast Texas: Segment 003	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	4	1					1	08/04/2022	2023.01	08/04/2022 10:20:00 AM Eastern Daylight Time	08/04/2022 05:53:29 PM Eastern Daylight Time	08/04/2022 05:53:30 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	MediGold	www.MediGold.com	MediGold No Premium (HMO)	01	01		1			H9827	001	0	2023	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	4	1					1	08/04/2022	2023.01	08/04/2022 10:21:11 AM Eastern Daylight Time	08/04/2022 05:53:30 PM Eastern Daylight Time	08/04/2022 05:53:31 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	MediGold	www.MediGold.com	MediGold Plus (HMO)	01	01		1			H9827	002	0	2023	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	3	1				0	0	07/12/2022	2023.01	07/12/2022 07:21:06 AM Eastern Daylight Time	06/06/2022 05:18:11 AM Eastern Daylight Time				07/12/2022 08:35:24 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	MediGold	www.MediGold.com	MediGold Cash Back No Premium MA Only (HMO)	01	01		1			H9827	003	0	2023	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			
H9827	004	0	1	01	01	H9827_004_0	4	1					0	08/04/2022	2023.01	08/04/2022 10:22:29 AM Eastern Daylight Time	08/04/2022 05:53:31 PM Eastern Daylight Time	08/04/2022 05:53:31 PM Eastern Daylight Time			08/04/2022 06:30:06 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	MediGold	www.MediGold.com	MediGold Cash Back No Premium (HMO)	01	01		1			H9827	004	0	2023	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	801	0	1	01	01	H9827_801_0	2	1						05/26/2022	2023.01	05/26/2022 02:59:28 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	MediGold	www.MediGold.com	MediGold EGWP 1 (HMO)	01	01		1			H9827	801	0	2023	Select Counties in New York		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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H9827	802	0	1	01	01	H9827_802_0	2	1						05/26/2022	2023.01	05/26/2022 03:03:16 PM Eastern Daylight Time					06/06/2022 12:11:44 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	MediGold	www.MediGold.com	MediGold EGWP 2 (HMO)	01	01		1			H9827	802	0	2023	Select Counties in New York		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;7b;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H9828	001	0	1	01	01	H9828_001_0	3	1						08/01/2022	2023.01	08/01/2022 06:48:05 PM Eastern Daylight Time	08/04/2022 01:51:44 PM Eastern Daylight Time	08/04/2022 01:51:44 PM Eastern Daylight Time			08/04/2022 04:04:32 PM Eastern Daylight Time	APEX HEALTH, INC.	ApexHealth	www.apexhealth.com	ApexBold (HMO)	01	01		1			H9828	001	0	2023	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	3	1						05/26/2022	2023.01	05/26/2022 11:19:17 AM Eastern Daylight Time	08/04/2022 01:51:44 PM Eastern Daylight Time	08/04/2022 01:51:44 PM Eastern Daylight Time			08/04/2022 04:04:32 PM Eastern Daylight Time	APEX HEALTH, INC.	ApexHealth	www.apexhealth.com	ApexEnrich (HMO)	01	01		1			H9828	002	0	2023	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	3	1						08/01/2022	2023.01	08/01/2022 04:33:20 PM Eastern Daylight Time	08/04/2022 01:51:44 PM Eastern Daylight Time	08/04/2022 01:51:44 PM Eastern Daylight Time			08/04/2022 04:04:32 PM Eastern Daylight Time	APEX HEALTH, INC.	ApexHealth	www.apexhealth.com	ApexBold (HMO)	01	01		1			H9828	003	0	2023	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						06/02/2022	2023.01	06/02/2022 10:10:25 AM Mountain Daylight Time		05/27/2022 04:17:02 PM Mountain Daylight Time			06/02/2022 10:11:14 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	2023	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						06/02/2022	2023.01	06/02/2022 10:10:39 AM Mountain Daylight Time		05/27/2022 04:25:54 PM Mountain Daylight Time			06/02/2022 10:11:14 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	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:46:09 AM Central Daylight Time	08/05/2022 04:23:38 PM Central Daylight Time	08/05/2022 04:23:43 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:47:05 AM Central Daylight Time	08/05/2022 04:23:38 PM Central Daylight Time	08/05/2022 04:23:43 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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	08/05/2022	2023.01	08/05/2022 11:47:59 AM Central Daylight Time	06/04/2022 06:17:08 AM Central Daylight Time				08/05/2022 02:56:06 PM 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	2023	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	08/05/2022	2023.01	08/05/2022 11:45:55 AM Central Daylight Time	06/04/2022 06:17:08 AM Central Daylight Time				08/05/2022 02:56:06 PM 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	2023	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	3	1					1	08/05/2022	2023.01	08/05/2022 11:49:03 AM Central Daylight Time	08/05/2022 04:23:39 PM Central Daylight Time	08/05/2022 04:23:44 PM Central Daylight Time			08/05/2022 04:53:50 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	2023	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						06/01/2022	2023.01	06/01/2022 01:09:31 PM Eastern Daylight Time		06/01/2022 12:19:44 PM Eastern Daylight Time			06/01/2022 01:11:15 PM Eastern Daylight Time	SAINT JOSEPH PACE	Saint Joseph PACE	trinityhealthpace.org	Saint Joseph PACE (PACE)	08	20		1			H9842	001	0	2023	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						06/01/2022	2023.01	06/01/2022 01:09:36 PM Eastern Daylight Time		06/01/2022 12:19:44 PM Eastern Daylight Time			06/01/2022 01:11:15 PM Eastern Daylight Time	SAINT JOSEPH PACE	Saint Joseph PACE	trinityhealthpace.org	Saint Joseph PACE - Medicare Only (PACE)	08	20		1			H9842	002	0	2023	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	6	1			2		1	08/10/2022	2023.01	08/10/2022 04:03:01 PM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time			08/10/2022 04:06:22 PM Eastern Daylight Time	RELIANCE HMO, INC.	Reliance Medicare Advantage	RelianceMedicareAdvantage.org	CCA Medicare Excel (HMO)	01	01		1			H9861	001	0	2023	Counties: GENE, LAPE, MACO, MONR, OAKL, ST.C, WAYN		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;	
H9861	002	0	1	01	01	H9861_002_0	6	1			2		1	08/10/2022	2023.01	08/10/2022 04:03:15 PM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time			08/10/2022 04:06:22 PM Eastern Daylight Time	RELIANCE HMO, INC.	Reliance Medicare Advantage	RelianceMedicareAdvantage.org	CCA Medicare Ultima (HMO)	01	01		1			H9861	002	0	2023	Counties: GENE, LAPE, MACO, MONR, OAKL, ST.C, WAYN		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	6	1	2	1	1		0	08/05/2022	2023.01	08/05/2022 11:47:04 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time			08/05/2022 01:00:46 PM Eastern Daylight Time	RELIANCE HMO, INC.	Reliance Medicare Advantage	RelianceMedicareAdvantage.org	CCA Medicare Maximum (HMO D-SNP)	01	01		1			H9861	003	0	2023	Counties: GENE, LAPE, MACO, OAKL, ST.C, WAYN		2		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	3	1						08/05/2022	2023.01	08/05/2022 12:53:37 PM Central Daylight Time					08/05/2022 01:25:58 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	2023	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	6	1			2		1	08/05/2022	2023.01	08/05/2022 12:13:24 PM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time			08/05/2022 01:23:46 PM Eastern Daylight Time	Commonwealth Care Alliance Rhode Island, LLC	Commonwealth Care Alliance Rhode Island	commonwealthcarealliance.org/ri/become-a-member	CCA Medicare Preferred (PPO)	01	04		1			H9876	001	0	2023	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/	(833)346-9222		(833)346-9222		(866)275-1222		(866)275-1222		(833)346-9222		(833)346-9222		(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	7	1			2		0	08/05/2022	2023.01	08/05/2022 11:16:56 AM Eastern Daylight Time	08/05/2022 11:07:08 AM Eastern Daylight Time	08/05/2022 11:07:09 AM Eastern Daylight Time			08/05/2022 01:23:46 PM Eastern Daylight Time	Commonwealth Care Alliance Rhode Island, LLC	Commonwealth Care Alliance Rhode Island	commonwealthcarealliance.org/ri/become-a-member	CCA Medicare Value (PPO)	01	04		1			H9876	002	0	2023	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/	(833)346-9222		(833)346-9222		(866)275-1222		(866)275-1222		(833)346-9222		(833)346-9222		(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	9	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 11:30:56 AM Eastern Daylight Time	08/04/2022 03:30:00 PM Eastern Daylight Time	08/04/2022 03:25:00 PM Eastern Daylight Time			08/04/2022 03:46:01 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	2023	Virginia		2		2			1	3		1					1	www.virginiapremier.com	www.virginiapremier.com	www.virginiapremier.com	(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9884	001	0	1	04	01	H9884_001_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:39:28 PM US Eastern Daylight Time	08/04/2022 09:56:23 AM Eastern Daylight Time	07/31/2022 02:07:51 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted CHOICE South Florida (PPO)	01	04		1			H9884	001	0	2023	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	9	1					1	08/03/2022	2023.01	08/03/2022 03:40:08 PM US Eastern Daylight Time	08/04/2022 09:56:53 AM Eastern Daylight Time	07/31/2022 02:08:13 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted CHOICE Orlando (PPO)	01	04		1			H9884	003	0	2023	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	9	1					1	08/03/2022	2023.01	08/03/2022 03:40:48 PM US Eastern Daylight Time	08/04/2022 09:57:25 AM Eastern Daylight Time	07/31/2022 02:08:34 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted CHOICE (PPO)	01	04		1			H9884	004	0	2023	Clay, Duval, Nassau, Flagler, & Volusia 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	08/03/2022	2023.01	08/03/2022 03:41:29 PM US Eastern Daylight Time	08/04/2022 09:57:52 AM Eastern Daylight Time	07/31/2022 02:08:56 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted CHOICE GIVEBACK Tampa (PPO)	01	04		1			H9884	005	0	2023	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	08/03/2022	2023.01	08/03/2022 03:42:20 PM US Eastern Daylight Time	08/04/2022 09:58:21 AM Eastern Daylight Time	07/31/2022 02:09:17 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted CHOICE GIVEBACK Polk (PPO)	01	04		1			H9884	006	0	2023	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	9	1					1	08/03/2022	2023.01	08/03/2022 03:43:03 PM US Eastern Daylight Time	08/04/2022 09:58:47 AM Eastern Daylight Time	07/31/2022 02:09:39 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted CHOICE Manatee (PPO)	01	04		1			H9884	007	0	2023	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			
H9884	008	0	1	04	01	H9884_008_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:44:00 PM US Eastern Daylight Time	08/04/2022 10:00:50 AM Eastern Daylight Time	07/31/2022 02:10:01 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted CHOICE East Coast Florida (PPO)	01	04		1			H9884	008	0	2023	Brevard, Indian River, Martin, St. Lucie 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	011	0	1	04	01	H9884_011_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:44:42 PM US Eastern Daylight Time	08/04/2022 10:01:15 AM Eastern Daylight Time	07/31/2022 02:10:22 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted CHOICE Northwest Florida (PPO)	01	04		1			H9884	011	0	2023	Escambia, Santa Rosa 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	012	0	1	04	01	H9884_012_0	10	1					1	08/03/2022	2023.01	08/03/2022 03:45:25 PM US Eastern Daylight Time	08/04/2022 09:59:17 AM Eastern Daylight Time	07/31/2022 02:10:44 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted CHOICE North Florida (PPO)	01	04		1			H9884	012	0	2023	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			
H9888	001	0	1	04	01	H9888_001_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:47:07 PM US Eastern Daylight Time	08/04/2022 10:01:39 AM Eastern Daylight Time	07/31/2022 02:11:05 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Devoted Health	www.Devoted.com	Devoted CHOICE Alabama (PPO)	01	04		1			H9888	001	0	2023	Birmingham, Mobile, Montgomery		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			
H9888	002	0	1	04	01	H9888_002_0	9	1					1	08/03/2022	2023.01	08/03/2022 03:46:52 PM US Eastern Daylight Time	08/04/2022 10:02:06 AM Eastern Daylight Time	07/31/2022 02:11:27 PM Eastern Daylight Time			08/05/2022 12:04:16 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Devoted Health	www.Devoted.com	Devoted CHOICE Alabama (PPO)	01	04		1			H9888	002	0	2023	Colbert and Lauderdale 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			
H9900	001	0	1	01	01	H9900_001_0	5	1						08/03/2022	2023.01	08/03/2022 03:48:53 PM Eastern Daylight Time	08/03/2022 09:38:51 PM Eastern Daylight Time	07/30/2022 11:01:43 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcareOK.com	Wellcare Giveback (HMO)	01	01		1			H9900	001	0	2023	Select counties in OK		2		2			2									www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:29:17 PM Eastern Daylight Time	08/03/2022 09:40:08 PM Eastern Daylight Time	07/30/2022 11:02:16 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcareOK.com	Wellcare Dual Access (HMO D-SNP)	01	01		1			H9900	002	0	2023	Select counties in OK		2		2			1	3		1					1	www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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	003	0	1	01	01	H9900_003_0	6	1	2	1	1		0	07/05/2022	2023.01	07/05/2022 12:31:50 PM Eastern Daylight Time	08/03/2022 09:41:22 PM Eastern Daylight Time	07/30/2022 11:02:49 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcareOK.com	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H9900	003	0	2023	Select counties in OK		2		2			1	3		1					1	www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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	004	0	1	01	01	H9900_004_0	5	1						08/01/2022	2023.01	08/01/2022 01:16:06 PM Eastern Daylight Time	08/03/2022 09:42:34 PM Eastern Daylight Time	07/30/2022 11:03:20 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcareOK.com	Wellcare No Premium (HMO)	01	01		1			H9900	004	0	2023	Select counties in OK		2		2			2									www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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						08/01/2022	2023.01	08/01/2022 01:17:22 PM Eastern Daylight Time	08/03/2022 09:43:46 PM Eastern Daylight Time	07/30/2022 11:03:52 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcareOK.com	Wellcare No Premium (HMO)	01	01		1			H9900	005	0	2023	Select counties in OK		2		2			2									www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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						06/01/2022	2023.01	06/01/2022 05:17:34 PM Eastern Daylight Time	08/03/2022 09:44:58 PM Eastern Daylight Time	07/30/2022 11:04:24 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcareOK.com	Wellcare Assist (HMO)	01	01		1			H9900	006	0	2023	Select counties in OK		2		2			2									www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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						05/25/2022	2023.01	05/25/2022 09:02:53 PM Eastern Daylight Time	08/03/2022 09:46:08 PM Eastern Daylight Time	07/30/2022 11:04:57 AM Eastern Daylight Time			08/04/2022 05:27:42 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcareOK.com	Wellcare Assist (HMO)	01	01		1			H9900	007	0	2023	Select counties in OK		2		2			2									www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(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	008	0	1	01	01	H9900_008_0	4	1				0	0	05/25/2022	2023.01	05/25/2022 09:04:24 PM Eastern Daylight Time	06/03/2022 08:39:49 PM Eastern Daylight Time				07/15/2022 04:34:34 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcareOK.com	Wellcare Patriot No Premium (HMO)	01	01		1			H9900	008	0	2023	Select Counties in OK		2		2			2									www.wellcareOK.com	www.wellcareOK.com	www.wellcareOK.com	(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9904	001	0	1	04	01	H9904_001_0	7	1					0	08/05/2022	2023.01	08/05/2022 09:40:51 AM Eastern Daylight Time	08/05/2022 10:03:35 AM Eastern Daylight Time	08/04/2022 08:39:32 PM Eastern Daylight Time			08/05/2022 12:24:23 PM Eastern Daylight Time	CENTRAL MASS HEALTH, LLC	Mass Advantage	https://www.massadvantage.com	Mass Advantage Premiere (PPO)	01	04		1			H9904	001	0	2023	Massachusetts (Partial)		2		2			2									https://www.massadvantage.com	https://www.massadvantage.com	https://www.massadvantage.com	(844)915-0234		(844)915-0234		(844)514-0674		(844)514-0674		(844)915-0234		(844)915-0234		(844)514-0674		(844)514-0674		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9907	001	0	1	04	01	H9907_001_0	8	1					0	08/04/2022	2023.01	08/04/2022 02:57:06 PM Eastern Daylight Time	08/04/2022 05:30:34 PM Eastern Daylight Time	08/02/2022 02:23:36 PM Eastern Daylight Time			08/05/2022 02:26:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred Access (PPO)	01	04		1			H9907	001	0	2023	Most of Massachusetts		2		2			2									www.tuftsmedicarepreferred.org/tufts-health-plan-doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(866)623-0172		(866)623-0172		(877)218-4835		(877)218-4835		(866)623-0172		(866)623-0172		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9907	801	0	1	04	01	H9907_801_0	3	1						09/29/2022	2023.01	09/29/2022 09:22:12 AM Eastern Daylight Time					09/29/2022 09:34:34 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred Access (PPO)	01	04		1			H9907	801	0	2023	Most of Massachusetts		1	12	2			2									https://www.tuftsmedicarepreferred.org/tufts-health-plan-doctor-search	tuftsmedicarepreferred.org/drug-coverage	https://www.tuftsmedicarepreferred.org/tufts-health-plan-doctor-search	(866)623-0172		(866)623-0172		(877)218-4835		(877)218-4835		(866)623-0172		(866)623-0172		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9907	802	0	1	04	01	H9907_802_0	4	1						10/03/2022	2023.01	10/03/2022 02:55:50 PM Eastern Daylight Time					10/03/2022 02:57:32 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred Access (PPO)	01	04		1			H9907	802	0	2023	Most of Massachusetts		1	12	2			2									https://www.tuftsmedicarepreferred.org/tufts-health-plan-doctor-search	tuftsmedicarepreferred.org/drug-coverage	https://www.tuftsmedicarepreferred.org/tufts-health-plan-doctor-search	(866)623-0172		(866)623-0172		(877)218-4835		(877)218-4835		(866)623-0172		(866)623-0172		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9909	001	0	1	01	01	H9909_001_0	4	1		1				08/02/2022	2023.01	08/02/2022 12:12:23 PM Central Daylight Time	08/01/2022 11:13:16 PM Central Daylight Time	07/29/2022 05:28:34 PM Central Daylight Time			08/03/2022 09:32:37 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	2023	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	1	01	7c;7i;	
H9917	001	0	1	01	01	H9917_001_0	6	1		1			1	08/09/2022	2023.01	08/09/2022 01:25:45 PM Eastern Daylight Time	08/09/2022 01:29:04 PM Eastern Daylight Time	08/05/2022 07:22:23 AM Eastern Daylight Time			08/10/2022 12:03:24 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	2023	Florida (partial)		2		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	5	1		1			1	08/09/2022	2023.01	08/09/2022 01:27:56 PM Eastern Daylight Time	08/05/2022 09:55:20 AM Eastern Daylight Time	08/05/2022 07:22:42 AM Eastern Daylight Time			08/10/2022 12:03:24 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	2023	Florida (partial)		2		2			1	4			00000100000000000000000					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	003	0	1	01	01	H9917_003_0	7	1		1			1	07/12/2022	2023.01	07/12/2022 11:42:27 AM Eastern Daylight Time		08/04/2022 04:22:18 PM Eastern Daylight Time		08/04/2022 03:49:04 PM Eastern Daylight Time	08/19/2022 07:11:04 PM Eastern Daylight Time	ALIGN SENIOR CARE FLORIDA, INC.	Align Senior Care	www.alignseniorcare.com	Align Kidney Care (HMO C-SNP)	01	01		1			H9917	003	0	2023	Florida (partial)		2		2			1	4			00000000100000000000000					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			
H9940	001	0	1	01	01	H9940_001_0	9	1		1				08/03/2022	2023.01	08/03/2022 05:00:50 PM Central Daylight Time	08/04/2022 12:24:27 PM Central Daylight Time	08/02/2022 08:37:56 AM Central Daylight Time			08/04/2022 03:18:36 PM Central Daylight Time	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Longevity Health Plan of Massachusetts	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	01	01		1			H9940	001	0	2023	MA (Partial)		2		2			1	1	1							www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(999)999-9999		(999)999-9999		(999)999-9999		(999)999-9999		(999)999-9999		(999)999-9999		(999)999-9999		(999)999-9999		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9942	001	0	1	04	01	H9942_001_0	5	1		1				08/03/2022	2023.01	08/03/2022 09:08:17 AM Central Daylight Time	08/02/2022 11:30:29 AM Central Daylight Time	08/02/2022 10:55:13 AM Central Daylight Time			08/04/2022 02:26:49 PM 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	2023	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			
H9943	001	0	1	02	01	H9943_001_0	5	1					0	08/05/2022	2023.01	08/05/2022 02:47:33 PM Pacific Daylight Time	08/05/2022 02:17:23 PM Pacific Daylight Time	08/02/2022 11:05:46 AM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Platinum (HMO-POS)	01	02		1			H9943	001	0	2023	Clay, Duval		2		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			
H9943	002	0	1	02	01	H9943_002_0	5	1					0	08/05/2022	2023.01	08/05/2022 02:47:52 PM Pacific Daylight Time	08/05/2022 02:17:16 PM Pacific Daylight Time	08/02/2022 11:09:28 AM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Platinum (HMO-POS)	01	02		1			H9943	002	0	2023	Sarasota, Manatee		2		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			
H9943	003	0	1	01	01	H9943_003_0	6	1		1			0	08/05/2022	2023.01	08/05/2022 02:48:14 PM Pacific Daylight Time	08/05/2022 02:17:16 PM Pacific Daylight Time	08/02/2022 02:29:54 PM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Heart & Diabetes (HMO C-SNP)	01	01		1			H9943	003	0	2023	Clay, Sarasota, Duval, Manatee		2		2			1	4			00000000000000000010000					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			
H9943	004	0	1	01	01	H9943_004_0	4	1	2	1			0	07/11/2022	2023.01	07/11/2022 10:19:12 AM Pacific Daylight Time	08/05/2022 02:17:19 PM Pacific Daylight Time	08/02/2022 11:10:50 AM Pacific Daylight Time			08/05/2022 03:10:20 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health the ONE (HMO D-SNP)	01	01		1			H9943	004	0	2023	Clay, Sarasota, Duval, Manatee		2		2			1	3		1					1	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			
H9943	801	0	1	01	01	H9943_801_0	2	1						06/04/2022	2023.01	06/04/2022 01:07:26 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H9943	801	0	2023	Clay, Sarasota, Duval, Manatee		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			
H9943	802	0	1	01	01	H9943_802_0	2	1						06/04/2022	2023.01	06/04/2022 01:10:10 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H9943	802	0	2023	Clay, Sarasota, Duval, Manatee		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			
H9943	803	0	1	01	01	H9943_803_0	2	1				0	0	06/04/2022	2023.01	06/04/2022 01:11:49 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H9943	803	0	2023	Clay, Sarasota, Duval, Manatee		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			
H9943	804	0	1	01	01	H9943_804_0	2	1				0	0	06/04/2022	2023.01	06/04/2022 12:56:01 PM Pacific Daylight Time					06/06/2022 05:39:53 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H9943	804	0	2023	Clay, Sarasota, Duval, Manatee		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			
H9952	001	0	1	01	01	H9952_001_0	7	1	2	1			0	08/04/2022	2023.01	08/04/2022 02:15:13 PM Central Daylight Time	08/10/2022 03:02:07 PM Central Daylight Time	08/04/2022 02:05:39 PM Central Daylight Time			08/10/2022 03:37:14 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica AccessAbility Solution Enhanced (HMO D-SNP)	01	01		1			H9952	001	0	2023	Greater Minneapolis/St. Paul Metro Area		2		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	08/04/2022	2023.01	08/04/2022 02:10:02 PM Pacific Daylight Time	08/04/2022 06:19:40 PM Pacific Daylight Time	08/01/2022 10:55:20 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	Select Counties In Ohio		2		2			1	3		1					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	7	1					1	08/04/2022	2023.01	08/04/2022 05:39:52 PM Pacific Daylight Time	08/04/2022 06:20:08 PM Pacific Daylight Time	08/01/2022 10:55:52 AM Pacific Daylight Time			08/04/2022 10:48:33 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	2023	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			
H9955	003	0	1	01	01	H9955_003_0	8	1	2	1			0	08/04/2022	2023.01	08/04/2022 05:40:26 PM Pacific Daylight Time	08/04/2022 06:20:34 PM Pacific Daylight Time	08/01/2022 10:56:20 AM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/medicare	Molina Medicare Complete Care Select (HMO D-SNP)	01	01		1			H9955	003	0	2023	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	004	0	1	01	01	H9955_004_0	7	1					1	08/04/2022	2023.01	08/04/2022 01:46:44 PM Pacific Daylight Time	08/04/2022 06:21:04 PM Pacific Daylight Time	08/01/2022 03:36:46 PM Pacific Daylight Time			08/04/2022 10:48:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/medicare	Molina Medicare Choice Care Select (HMO)	01	01		1			H9955	004	0	2023	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						06/02/2022	2023.01	06/02/2022 12:12:05 PM Eastern Daylight Time	08/03/2022 07:45:38 PM Eastern Daylight Time	07/30/2022 11:05:29 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in NM		2		2			2									www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9976	002	0	1	04	01	H9976_002_0	4	1						08/02/2022	2023.01	08/02/2022 10:13:09 AM Eastern Daylight Time	08/03/2022 07:47:09 PM Eastern Daylight Time	07/30/2022 11:06:01 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in NM		2		2			2									www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9976	004	0	1	04	01	H9976_004_0	4	1						08/02/2022	2023.01	08/02/2022 10:15:45 AM Eastern Daylight Time	08/03/2022 07:48:41 PM Eastern Daylight Time	07/30/2022 11:06:32 AM Eastern Daylight Time			08/04/2022 05:06:33 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	2023	Select counties in NM		2		2			2									www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(833)543-0246		(833)543-0246		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9986	001	0	1	01	01	H9986_001_0	6	1		1				08/05/2022	2023.01	08/05/2022 07:36:33 AM Eastern Daylight Time	08/04/2022 12:11:11 PM Eastern Daylight Time	08/04/2022 11:44:36 AM Eastern Daylight Time			08/05/2022 08:06:15 AM Eastern Daylight Time	HPMP OF FLORIDA, INC.	Florida Complete Care	www.fc2healthplan.com	Florida Complete Care (HMO I-SNP)	01	01		1			H9986	001	0	2023	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		(844)740-0625		(844)740-0625		(833)322-7526		(833)322-7526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9986	002	0	1	01	01	H9986_002_0	7	1		1				08/05/2022	2023.01	08/05/2022 07:34:25 AM Eastern Daylight Time	08/04/2022 12:26:46 PM Eastern Daylight Time	08/04/2022 11:51:56 AM Eastern Daylight Time			08/05/2022 08:06:15 AM Eastern 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	2023	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		(844)740-0625		(844)740-0625		(833)322-7526		(833)322-7526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9998	001	0	1	20	08	H9998_001_0	1	1						06/01/2022	2023.01	06/01/2022 12:43:57 PM Central Daylight Time		06/01/2022 01:40:48 PM Central Daylight Time			06/01/2022 01:43:08 PM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstar.org	Silver Star - Dual (PACE)	08	20		1			H9998	001	0	2023	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	2	1						06/02/2022	2023.01	06/02/2022 12:42:42 PM Central Daylight Time		06/02/2022 12:40:23 PM Central Daylight Time			06/02/2022 12:43:07 PM 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	2023	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	3	1				0	0	05/30/2022	2023.01	05/30/2022 01:54:49 PM Eastern Daylight Time	08/03/2022 03:46:42 PM Eastern Daylight Time				08/04/2022 09:43:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-001 (Regional PPO)	11	31		1			R0110	001	0	2023	States of Louisiana and Mississippi		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1			1		1	08/16/2022	2023.01	08/16/2022 04:10:06 PM Eastern Daylight Time	08/03/2022 04:04:50 PM Eastern Daylight Time	07/30/2022 10:00:42 AM Eastern Daylight Time			08/16/2022 05:39:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-003 (Regional PPO)	11	31		1			R0110	003	0	2023	States of Louisiana and Mississippi		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1						06/03/2022	2023.01	06/03/2022 08:08:23 AM Eastern Daylight Time					06/03/2022 08:08:39 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0110	801	0	2023	States of Louisiana and Mississippi		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	05/27/2022	2023.01	05/27/2022 12:23:46 PM Eastern Daylight Time					05/27/2022 12:24:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0110	802	0	2023	States of Louisiana and Mississippi		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1					1	08/03/2022	2023.01	08/03/2022 09:23:07 AM Central Daylight Time	08/03/2022 11:06:32 AM Central Daylight Time	07/31/2022 04:02:20 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (Regional PPO)	11	31		1			R0759	001	0	2023	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	2	1				0	0	05/29/2022	2023.01	05/29/2022 08:46:10 AM Central Daylight Time	08/03/2022 11:07:14 AM Central Daylight Time				08/04/2022 02:18:32 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (Regional PPO)	11	31		1			R0759	002	0	2023	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	2	1	2	1			0	08/03/2022	2023.01	08/03/2022 09:23:29 AM Central Daylight Time	08/03/2022 11:07:55 AM Central Daylight Time	07/31/2022 04:02:45 AM Central Daylight Time			08/04/2022 02:00:23 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)	11	31		1			R0759	003	0	2023	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			
R0865	001	0	1	31	11	R0865_001_0	5	1				0	0	08/01/2022	2023.01	08/01/2022 01:29:39 PM Eastern Daylight Time	08/03/2022 04:29:40 PM Eastern Daylight Time				08/04/2022 05:11:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0865-001 (Regional PPO)	11	31		1			R0865	001	0	2023	States of Indiana and Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R0865	003	0	1	31	11	R0865_003_0	3	1			1		1	08/02/2022	2023.01	08/02/2022 04:45:57 PM Eastern Daylight Time	08/03/2022 05:00:32 PM Eastern Daylight Time	07/30/2022 10:01:08 AM Eastern Daylight Time			08/04/2022 05:11:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0865-003 (Regional PPO)	11	31		1			R0865	003	0	2023	States of Indiana and Kentucky		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/31/2022	2023.01	05/31/2022 11:18:25 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0865	801	0	2023	States of Indiana and Kentucky		1	3714	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/31/2022	2023.01	05/31/2022 11:19:59 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0865	802	0	2023	States of Indiana and Kentucky		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/28/2022	2023.01	05/28/2022 10:28:26 AM Eastern Daylight Time	08/03/2022 04:28:51 PM Eastern Daylight Time				08/04/2022 05:19:22 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0923-001 (Regional PPO)	11	31		1			R0923	001	0	2023	States of Pennsylvania and West Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1		1	05/31/2022	2023.01	05/31/2022 04:37:21 PM Eastern Daylight Time	08/03/2022 04:58:05 PM Eastern Daylight Time	07/30/2022 10:01:34 AM Eastern Daylight Time			08/04/2022 05:19:22 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0923-002 (Regional PPO)	11	31		1			R0923	002	0	2023	States of Pennsylvania and West Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/31/2022	2023.01	05/31/2022 09:51:37 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0923	801	0	2023	States of Pennsylvania and West Verginia		1	1750	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/31/2022	2023.01	05/31/2022 09:53:03 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0923	802	0	2023	States of Pennsylvania and West Verginia		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	08/01/2022	2023.01	08/01/2022 03:33:18 PM Eastern Daylight Time	08/03/2022 03:59:34 PM Eastern Daylight Time				08/04/2022 03:07:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1390-001 (Regional PPO)	11	31		1			R1390	001	0	2023	North Carolina and Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1			1		1	08/01/2022	2023.01	08/01/2022 04:38:59 PM Eastern Daylight Time	08/03/2022 04:00:04 PM Eastern Daylight Time	07/30/2022 10:02:00 AM Eastern Daylight Time			08/04/2022 03:07:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1390-002 (Regional PPO)	11	31		1			R1390	002	0	2023	North Carolina and Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/01/2022	2023.01	08/01/2022 03:33:31 PM Eastern Daylight Time	08/03/2022 04:16:26 PM Eastern Daylight Time				08/04/2022 03:07:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (Regional PPO)	11	31		1			R1390	003	0	2023	North Carolina and Virginia		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1						05/27/2022	2023.01	05/27/2022 12:11:29 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1390	801	0	2023	States of North Carolina and Virginia		1	1631	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 12:12:22 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1390	802	0	2023	States of North Carolina and Virginia		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	08/03/2022	2023.01	08/03/2022 11:41:59 AM Eastern Daylight Time	08/03/2022 03:38:18 PM Eastern Daylight Time				08/04/2022 11:21:39 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1532-001 (Regional PPO)	11	31		1			R1532	001	0	2023	States of Arkansas and Missouri		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1						08/03/2022	2023.01	08/03/2022 11:35:39 AM Eastern Daylight Time	08/03/2022 04:08:42 PM Eastern Daylight Time	07/30/2022 10:02:26 AM Eastern Daylight Time			08/04/2022 11:21:39 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1532-002 (Regional PPO)	11	31		1			R1532	002	0	2023	States of Arkansas and Missouri		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/27/2022	2023.01	05/27/2022 12:12:48 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1532	801	0	2023	States of Arkansas and Missouri		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 12:13:10 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1532	802	0	2023	States of Arkansas and Missouri		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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									
R2604	001	0	1	31	11	R2604_001_0	2	1					1	08/04/2022	2023.01	08/04/2022 03:13:21 PM Central Daylight Time	08/03/2022 11:08:57 AM Central Daylight Time	07/31/2022 04:03:10 AM Central Daylight Time			08/04/2022 04:34:56 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice (Regional PPO)	11	31		1			R2604	001	0	2023	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	08/04/2022	2023.01	08/04/2022 11:54:58 AM Central Daylight Time	08/03/2022 11:09:37 AM Central Daylight Time	07/31/2022 04:03:36 AM Central Daylight Time			08/04/2022 04:34:56 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			R2604	002	0	2023	Georgia and South Carolina		2		2			1	4			00000000000000000010000					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	2	1		1			1	08/04/2022	2023.01	08/04/2022 12:00:29 PM Central Daylight Time	08/03/2022 11:10:20 AM Central Daylight Time	07/31/2022 04:04:00 AM Central Daylight Time			08/04/2022 04:34:56 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			R2604	003	0	2023	Georgia and South Carolina		2		2			1	4			00000000000000000010000					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	08/04/2022	2023.01	08/04/2022 11:51:28 AM Central Daylight Time	08/03/2022 11:11:06 AM Central Daylight Time				08/04/2022 04:34:56 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Patriot (Regional PPO)	11	31		1			R2604	005	0	2023	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	2	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 09:53:40 AM Central Daylight Time	08/03/2022 10:28:22 AM Central Daylight Time	07/31/2022 04:04:26 AM Central Daylight Time			08/04/2022 03:47:24 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	2023	State of Hawaii		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			
R3175	801	0	1	31	11	R3175_801_0	2	1						06/03/2022	2023.01	06/03/2022 10:47:58 AM Eastern Daylight Time					06/03/2022 03:33:06 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	801	0	2023	State of Hawaii		1	0	2			2									www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	2	1				0	0	06/03/2022	2023.01	06/03/2022 10:48:14 AM Eastern Daylight Time					06/03/2022 03:33:06 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	802	0	2023	State of Hawaii		1	0	2			2									www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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	12	1					1	08/09/2022	2023.01	08/09/2022 07:19:31 PM Eastern Daylight Time	08/09/2022 07:16:04 PM Eastern Daylight Time	08/03/2022 05:43:09 PM Eastern Daylight Time			08/09/2022 09:18:28 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	2023	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	4	1				0	0	08/04/2022	2023.01	08/04/2022 11:13:56 AM Eastern Daylight Time	08/03/2022 05:24:10 PM Eastern Daylight Time				08/04/2022 03:56:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3392-001 (Regional PPO)	11	31		1			R3392	001	0	2023	States of Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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			2		1	08/01/2022	2023.01	08/01/2022 06:55:49 PM Eastern Daylight Time	08/03/2022 05:24:36 PM Eastern Daylight Time	07/30/2022 10:02:52 AM Eastern Daylight Time			08/04/2022 03:56:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3392-002 (Regional PPO)	11	31		1			R3392	002	0	2023	States of Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3392	004	0	1	31	11	R3392_004_0	4	1			2		1	08/02/2022	2023.01	08/02/2022 10:53:49 AM Eastern Daylight Time	08/03/2022 05:40:00 PM Eastern Daylight Time	07/30/2022 10:03:16 AM Eastern Daylight Time			08/04/2022 03:38:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3392-004 (Regional PPO)	11	31		1			R3392	004	0	2023	States of Georgia and South Carolina		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/27/2022	2023.01	05/27/2022 12:13:43 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3392	801	0	2023	States of Georgia and South Carolina		1	2335	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 12:14:15 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3392	802	0	2023	States of Georgia and South Carolina		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	08/03/2022	2023.01	08/03/2022 05:44:42 PM Central Daylight Time	08/03/2022 11:28:57 AM Central Daylight Time	07/31/2022 04:04:51 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	Arkansas and Missouri		2		2			1	4			00000000000000000010000					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	08/03/2022	2023.01	08/03/2022 05:47:03 PM Central Daylight Time	08/03/2022 11:29:36 AM Central Daylight Time	07/31/2022 04:05:16 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	Arkansas and Missouri		2		2			1	4			00000000000000000010000					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	3	1					1	08/03/2022	2023.01	08/03/2022 05:49:18 PM Central Daylight Time	08/03/2022 11:30:20 AM Central Daylight Time	07/31/2022 04:05:41 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	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	3	1					1	08/03/2022	2023.01	08/03/2022 05:51:46 PM Central Daylight Time	08/03/2022 11:31:02 AM Central Daylight Time	07/31/2022 04:06:06 AM Central Daylight Time			08/05/2022 11:15:56 AM 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	2023	Arkansas and Missouri		2		2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3887	001	0	1	31	11	R3887_001_0	4	1				0	0	05/30/2022	2023.01	05/30/2022 07:43:45 PM Eastern Daylight Time	08/03/2022 04:20:39 PM Eastern Daylight Time				08/04/2022 12:11:10 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3887-001 (Regional PPO)	11	31		1			R3887	001	0	2023	State of Michigan		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/29/2022	2023.01	05/29/2022 01:48:45 PM Eastern Daylight Time	08/03/2022 04:47:06 PM Eastern Daylight Time	07/30/2022 10:03:42 AM Eastern Daylight Time			08/04/2022 12:11:10 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3887-002 (Regional PPO)	11	31		1			R3887	002	0	2023	State of Michigan		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/27/2022	2023.01	05/27/2022 12:14:40 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3887	801	0	2023	State of Michigan		1	2091	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 12:15:02 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3887	802	0	2023	State of Michigan		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	08/04/2022	2023.01	08/04/2022 02:30:34 PM Eastern Daylight Time	08/03/2022 03:39:50 PM Eastern Daylight Time				08/04/2022 02:32:07 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-001 (Regional PPO)	11	31		1			R4182	001	0	2023	State of Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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			2		1	05/31/2022	2023.01	05/31/2022 05:31:19 PM Eastern Daylight Time	08/03/2022 03:51:52 PM Eastern Daylight Time	07/30/2022 10:04:08 AM Eastern Daylight Time			08/04/2022 01:48:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-003 (Regional PPO)	11	31		1			R4182	003	0	2023	State of Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	05/31/2022	2023.01	05/31/2022 05:33:04 PM Eastern Daylight Time	08/03/2022 03:40:43 PM Eastern Daylight Time	07/30/2022 10:04:34 AM Eastern Daylight Time			08/04/2022 01:48:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-004 (Regional PPO)	11	31		1			R4182	004	0	2023	State of Texas		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/31/2022	2023.01	05/31/2022 09:46:29 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4182	801	0	2023	State of Texas		1	2458	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1				0	0	05/31/2022	2023.01	05/31/2022 11:42:53 PM Eastern Daylight Time					05/31/2022 11:43:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4182	802	0	2023	State of Texas		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	6	1						06/09/2022	2023.01	06/09/2022 05:57:27 PM Eastern Daylight Time	08/04/2022 06:17:31 PM Eastern Daylight Time	08/04/2022 06:31:28 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	05/31/2022	2023.01	05/31/2022 02:14:11 PM Eastern Daylight Time	08/03/2022 03:38:48 PM Eastern Daylight Time				08/04/2022 10:57:40 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4845-001 (Regional PPO)	11	31		1			R4845	001	0	2023	States of Kansas and Oklahoma		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/31/2022	2023.01	05/31/2022 02:15:09 PM Eastern Daylight Time	08/03/2022 04:08:09 PM Eastern Daylight Time	07/30/2022 10:05:00 AM Eastern Daylight Time			08/04/2022 10:57:40 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4845-002 (Regional PPO)	11	31		1			R4845	002	0	2023	States of Kansas and Oklahoma		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/31/2022	2023.01	05/31/2022 09:47:05 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4845	801	0	2023	States of Kansas and Oklahoma		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/27/2022	2023.01	05/27/2022 12:16:44 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4845	802	0	2023	States of Kansas and Oklahoma		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1					1	06/01/2022	2023.01	06/01/2022 09:08:32 PM Central Daylight Time	08/03/2022 11:07:03 AM Central Daylight Time	07/31/2022 04:06:30 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (Regional PPO)	11	31		1			R5329	001	0	2023	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	2	1					1	08/04/2022	2023.01	08/04/2022 02:39:12 PM Central Daylight Time	08/03/2022 11:16:43 AM Central Daylight Time	07/31/2022 04:06:55 AM Central Daylight Time			08/04/2022 05:25:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)	11	31		1			R5342	001	0	2023	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	2	1				0	0	05/31/2022	2023.01	05/31/2022 09:28:37 PM Central Daylight Time	08/03/2022 11:17:22 AM Central Daylight Time				08/04/2022 05:25:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Patriot (Regional PPO)	11	31		1			R5342	002	0	2023	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	2	1					1	05/31/2022	2023.01	05/31/2022 09:30:52 PM Central Daylight Time	08/03/2022 11:18:00 AM Central Daylight Time	07/31/2022 04:07:19 AM Central Daylight Time			08/04/2022 05:25:25 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			R5342	005	0	2023	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	2	1					1	05/31/2022	2023.01	05/31/2022 09:32:59 PM Central Daylight Time	08/03/2022 11:18:38 AM Central Daylight Time	07/31/2022 04:07:44 AM Central Daylight Time			08/04/2022 05:25:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)	11	31		1			R5342	006	0	2023	State of New York		2		2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5342	801	0	1	31	11	R5342_801_0	1	1						06/03/2022	2023.01	06/03/2022 10:48:47 AM Eastern Daylight Time					06/03/2022 03:16:45 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	801	0	2023	State of New York		1	156	2			2									www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(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	1	1				0	0	06/03/2022	2023.01	06/03/2022 10:49:03 AM Eastern Daylight Time					06/03/2022 03:16:45 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	802	0	2023	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	1	1						06/03/2022	2023.01	06/03/2022 10:49:20 AM Eastern Daylight Time					06/03/2022 03:16:45 PM Eastern Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	803	0	2023	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	3	1				0	0	05/29/2022	2023.01	05/29/2022 01:07:42 PM Eastern Daylight Time	08/03/2022 03:41:51 PM Eastern Daylight Time				08/04/2022 11:14:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (Regional PPO)	11	31		1			R5361	001	0	2023	States of Illinois and Wisconsin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						07/21/2022	2023.01	07/21/2022 11:36:01 AM Eastern Daylight Time	08/03/2022 04:24:29 PM Eastern Daylight Time	07/30/2022 10:05:24 AM Eastern Daylight Time			08/04/2022 11:14:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5361-002 (Regional PPO)	11	31		1			R5361	002	0	2023	States of Illinois and Wisconsin		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/31/2022	2023.01	05/31/2022 10:28:31 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5361	801	0	2023	States of Illinois and Wisconsin		1	5914	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/31/2022	2023.01	05/31/2022 10:33:05 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5361	802	0	2023	States of Illnois and Wisconsin		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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				0	0	08/02/2022	2023.01	08/02/2022 12:57:45 PM Eastern Daylight Time	08/03/2022 04:19:12 PM Eastern Daylight Time				08/04/2022 12:19:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5495-001 (Regional PPO)	11	31		1			R5495	001	0	2023	State of Ohio		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	4	1						06/02/2022	2023.01	06/02/2022 10:19:09 AM Eastern Daylight Time	08/03/2022 04:48:25 PM Eastern Daylight Time	07/30/2022 10:05:50 AM Eastern Daylight Time			08/04/2022 12:19:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5495-002 (Regional PPO)	11	31		1			R5495	002	0	2023	State of Ohio		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/31/2022	2023.01	05/31/2022 10:34:20 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5495	801	0	2023	State of Ohio		1	2067	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/31/2022	2023.01	05/31/2022 10:34:36 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5495	802	0	2023	State of Ohio		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			2		1	05/29/2022	2023.01	05/29/2022 02:53:28 PM Eastern Daylight Time	08/03/2022 05:33:18 PM Eastern Daylight Time	07/30/2022 10:06:16 AM Eastern Daylight Time			08/04/2022 01:45:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-005 (Regional PPO)	11	31		1			R5826	005	0	2023	State of Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			2	0	0	08/01/2022	2023.01	08/01/2022 03:01:35 PM Eastern Daylight Time	08/03/2022 05:32:24 PM Eastern Daylight Time				08/04/2022 02:19:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-018 (Regional PPO)	11	31		1			R5826	018	0	2023	State of Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	2	1			2		1	05/29/2022	2023.01	05/29/2022 02:53:50 PM Eastern Daylight Time	08/03/2022 05:32:50 PM Eastern Daylight Time	07/30/2022 10:06:42 AM Eastern Daylight Time			08/04/2022 01:45:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-074 (Regional PPO)	11	31		1			R5826	074	0	2023	State of Florida		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/31/2022	2023.01	05/31/2022 10:35:02 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	805	0	2023	State of Florida		1	5661	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/31/2022	2023.01	05/31/2022 10:35:23 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	819	0	2023	State of Florida		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	5	1				0	0	08/01/2022	2023.01	08/01/2022 04:08:37 PM Eastern Daylight Time	08/04/2022 06:17:32 PM Eastern Daylight Time				08/04/2022 09:35:16 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	2023	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	6	1						07/25/2022	2023.01	07/25/2022 10:05:03 AM Eastern Daylight Time	08/04/2022 06:17:34 PM Eastern Daylight Time	08/04/2022 06:31:31 PM Eastern Daylight Time			08/04/2022 09:35:16 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	2023	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	5	1						05/31/2022	2023.01	05/31/2022 04:15:54 PM Eastern Daylight Time	08/04/2022 01:30:48 PM Eastern Daylight Time	08/01/2022 12:57:12 AM Eastern Daylight Time			08/05/2022 08:57:44 AM 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	2023	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	4	1						05/31/2022	2023.01	05/31/2022 04:16:36 PM Eastern Daylight Time	08/04/2022 01:31:48 PM Eastern Daylight Time	08/01/2022 12:57:38 AM Eastern Daylight Time			08/05/2022 08:57:44 AM 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	2023	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	2	1						05/26/2022	2023.01	05/26/2022 02:39:43 PM Eastern Daylight Time	08/04/2022 12:28:59 PM Central Daylight Time	07/31/2022 11:58:06 PM Central Daylight Time			08/04/2022 03:58:19 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (Regional PPO)	11	31		1			R6694	006	0	2023	New Jersey Counties: All		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			
R6801	008	0	1	31	11	R6801_008_0	3	1		1	2		0	08/03/2022	2023.01	08/03/2022 05:46:11 PM Central Daylight Time	08/03/2022 11:51:04 AM Central Daylight Time	07/31/2022 04:08:10 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO C-SNP)	11	31		1			R6801	008	0	2023	Texas		2		2			1	4			00000000000000000010000					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	08/03/2022	2023.01	08/03/2022 05:46:23 PM Central Daylight Time	08/03/2022 11:51:43 AM Central Daylight Time	07/31/2022 04:08:36 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO C-SNP)	11	31		1			R6801	009	0	2023	Texas		2		2			1	4			00000000000000000010000					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	3	1	2	1	1		0	08/03/2022	2023.01	08/03/2022 05:47:47 PM Central Daylight Time	08/03/2022 11:52:22 AM Central Daylight Time	07/31/2022 04:09:01 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)	11	31		1			R6801	011	0	2023	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	3	1			2		1	08/03/2022	2023.01	08/03/2022 05:46:42 PM Central Daylight Time	08/03/2022 11:53:01 AM Central Daylight Time	07/31/2022 04:09:26 AM Central Daylight Time			08/05/2022 10:51:58 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice (Regional PPO)	11	31		1			R6801	012	0	2023	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	05/28/2022	2023.01	05/28/2022 11:51:44 AM Eastern Daylight Time	08/03/2022 03:38:33 PM Eastern Daylight Time				08/04/2022 03:15:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7220-001 (Regional PPO)	11	31		1			R7220	001	0	2023	State of Arizona		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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						05/28/2022	2023.01	05/28/2022 11:52:00 AM Eastern Daylight Time	08/03/2022 03:39:42 PM Eastern Daylight Time	07/30/2022 10:07:06 AM Eastern Daylight Time			08/04/2022 03:15:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7220-002 (Regional PPO)	11	31		1			R7220	002	0	2023	State of Arizona		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/31/2022	2023.01	05/31/2022 10:35:59 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7220	801	0	2023	State of Arizona		1	1220	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/31/2022	2023.01	05/31/2022 10:37:16 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7220	802	0	2023	State of Arizona		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	08/04/2022	2023.01	08/04/2022 12:03:14 PM Eastern Daylight Time	08/03/2022 03:35:14 PM Eastern Daylight Time				08/04/2022 12:28:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7315-001 (Regional PPO)	11	31		1			R7315	001	0	2023	States of Alabama and Tennessee		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1			1			06/02/2022	2023.01	06/02/2022 07:02:18 PM Eastern Daylight Time	08/03/2022 04:22:41 PM Eastern Daylight Time	07/30/2022 10:07:32 AM Eastern Daylight Time			08/04/2022 12:28:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7315-002 (Regional PPO)	11	31		1			R7315	002	0	2023	States of Alabama and Tennessee		2		2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/31/2022	2023.01	05/31/2022 10:38:11 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7315	801	0	2023	States of Alabama and Tennessee		1	1673	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1				0	0	05/31/2022	2023.01	05/31/2022 10:38:28 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7315	802	0	2023	States of Alabama and Tennessee		1	1200	2			2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list	https://finder.humana.com/finder/medical	(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	3	1					1	06/01/2022	2023.01	06/01/2022 09:08:52 PM Central Daylight Time	08/03/2022 11:12:12 AM Central Daylight Time	07/31/2022 04:09:51 AM Central Daylight Time			08/04/2022 02:21:09 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (Regional PPO)	11	31		1			R7444	001	0	2023	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			
S0156	801	0		29	10	S0156_801_0	4	1						05/23/2022	2023.01	05/23/2022 10:08:38 AM Eastern Daylight Time					06/06/2022 07:13:11 PM Eastern Daylight Time	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	NextBlue of North Dakota	www.nextblueND.com	NextBlue of North Dakota Group PDP (PDP)	10	29					S0156	801	0	2023	North Dakota		1					2									www.nextblueND.com/pharmacies	www.nextblueND.com/formularies										(855)812-4306		(855)812-4306		(855)812-4306		(855)812-4306										(711)-		(711)-		(711)-		(711)-																
S0586	801	0		29	10	S0586_801_0	4	1						05/02/2022	2023.01	05/02/2022 08:45:37 AM Eastern Daylight Time					06/06/2022 02:21:56 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP Health Care	www.mvphealthcare.com	MVP RxCare - Employer Group (PDP)	10	29					S0586	801	0	2023	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	1	1						06/06/2022	2023.01	06/06/2022 08:34:23 PM Eastern Daylight Time					06/06/2022 10:55:21 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	2023	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	1	1						06/06/2022	2023.01	06/06/2022 08:34:36 PM Eastern Daylight Time					06/06/2022 10:55:21 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	2023	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						06/01/2022	2023.01	06/01/2022 03:28:32 PM Central Daylight Time		06/03/2022 10:38:48 PM Central Daylight Time			06/06/2022 10:11:47 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Enhanced Plus (PDP)	10	29					S1030	001	0	2023	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						06/02/2022	2023.01	06/02/2022 01:54:03 PM Central Daylight Time		06/03/2022 10:39:16 PM Central Daylight Time			06/06/2022 09:51:42 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Essential (PDP)	10	29					S1030	006	0	2023	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						06/02/2022	2023.01	06/02/2022 11:24:25 AM Central Daylight Time		06/03/2022 10:39:50 PM Central Daylight Time			06/06/2022 09:51:42 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Enhanced (PDP)	10	29					S1030	010	0	2023	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						05/16/2022	2023.01	05/16/2022 07:05:06 PM Central Daylight Time					06/05/2022 01:23:38 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	2023	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						05/25/2022	2023.01	05/25/2022 01:41:01 PM Central Daylight Time					06/06/2022 10:13:13 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	2023	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						05/16/2022	2023.01	05/16/2022 07:05:11 PM Central Daylight Time					06/05/2022 01:23:38 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	2023	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						05/25/2022	2023.01	05/25/2022 01:41:10 PM Central Daylight Time					06/06/2022 10:13:13 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	2023	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						05/16/2022	2023.01	05/16/2022 07:05:16 PM Central Daylight Time					06/05/2022 01:23:38 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	2023	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	2	1						06/03/2022	2023.01	06/03/2022 02:03:39 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Group PDP (PDP)	10	29					S1140	801	0	2023	New York State		1					2									www.medicare.highmark.com	www.medicare.highmark.com										(877)461-9218		(877)461-9218		(877)640-6690		(877)640-6690										(711)-		(711)-		(711)-		(711)-																
S1140	802	0		29	10	S1140_802_0	2	1						06/03/2022	2023.01	06/03/2022 02:03:44 PM Eastern Daylight Time					06/03/2022 04:15:20 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	Highmark BCBS of WNY and Highmark BS of NENY	www.medicare.highmark.com	Group PDP Enhanced (PDP)	10	29					S1140	802	0	2023	New York State		1					2									www.medicare.highmark.com	www.medicare.highmark.com										(877)461-9218		(877)461-9218		(877)461-9218		(877)461-9218										(711)-		(711)-		(711)-		(711)-																
S1822	801	0		29	10	S1822_801_0	1	1						05/09/2022	2023.01	05/09/2022 09:26:16 AM Central Daylight Time					06/03/2022 11:03:25 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree National Choice PDP CY (PDP)	10	29					S1822	801	0	2023	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						05/09/2022	2023.01	05/09/2022 09:26:32 AM Central Daylight Time					06/03/2022 11:03:25 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree National Choice PDP NCY (PDP)	10	29					S1822	802	0	2023	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	5	1						05/23/2022	2023.01	05/23/2022 01:28:14 PM Eastern Daylight Time					06/06/2022 04:04:20 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Rx - Calendar Year (PDP)	10	29					S2465	801	0	2023	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	5	1						05/23/2022	2023.01	05/23/2022 01:28:17 PM Eastern Daylight Time					06/06/2022 04:04:20 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Rx Non-Calendar Year (PDP)	10	29					S2465	802	0	2023	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						05/31/2022	2023.01	05/31/2022 10:59:26 AM Pacific Daylight Time		05/26/2022 06:51:14 PM Pacific Daylight Time			06/03/2022 03:08:38 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Rx Plus (PDP)	10	29					S2468	003	0	2023	State of California		2					2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023										(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						05/26/2022	2023.01	05/26/2022 10:05:51 AM Pacific Daylight Time		05/26/2022 06:51:16 PM Pacific Daylight Time			06/03/2022 03:08:38 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Rx Enhanced (PDP)	10	29					S2468	004	0	2023	State of California		2					2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023										(888)239-6469		(888)239-6469		(888)292-7591		(888)292-7591										(711)-		(711)-		(711)-		(711)-																
S2468	801	0		29	10	S2468_801_0	1	1						04/28/2022	2023.01	04/28/2022 05:36:22 PM Pacific Daylight Time					06/03/2022 03:08:38 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	801	0	2023	PDP Employer Group Plan		1					2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023										(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-																
S2468	802	0		29	10	S2468_802_0	1	1						04/28/2022	2023.01	04/28/2022 05:36:28 PM Pacific Daylight Time					06/03/2022 03:08:38 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	802	0	2023	PDP Employer Group Plan		1					2									blueshieldca.com/medpharmacy2023	blueshieldca.com/medformulary2023										(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-																
S2668	005	0		29	10	S2668_005_0	6	1						06/06/2022	2023.01	06/06/2022 10:23:03 PM India Standard Time		06/05/2022 06:08:59 PM Central Daylight Time			06/06/2022 12:04:32 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	2023	Alabama and Tennessee		2					2									https://fbhealthplans.com/part-d/	https://fbhealthplans.com/part-d/formulary/										(866)643-6924		(866)643-6924		(844)368-8738		(844)368-8738										(711)-		(711)-		(711)-		(711)-																
S2668	006	0		29	10	S2668_006_0	6	1					1	06/06/2022	2023.01	06/06/2022 10:23:22 PM India Standard Time		06/05/2022 06:10:03 PM Central Daylight Time			06/06/2022 12:04:32 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	2023	Alabama and Tennessee		2					2									https://fbhealthplans.com/part-d/	fbhp.com/part-d/formulary/										(866)643-6924		(866)643-6924		(844)368-8738		(844)368-8738										(711)-		(711)-		(711)-		(711)-																
S2874	001	0		29	10	S2874_001_0	3	1					1	05/28/2022	2023.01	05/28/2022 08:40:26 AM Eastern Daylight Time		07/14/2022 11:51:32 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S2874	001	0	2023	Puerto Rico - Island Wide		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 08:41:11 AM Eastern Daylight Time		05/31/2022 11:53:04 AM Eastern Daylight Time			06/02/2022 10:16:57 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	2023	Puerto Rico - Island Wide		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	4	1						05/20/2022	2023.01	05/20/2022 12:13:49 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S2874	801	0	2023	Puerto Rico - Island Wide		1					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-																
S2893	001	0		29	10	S2893_001_0	3	1						06/02/2022	2023.01	06/02/2022 03:06:14 PM Eastern Daylight Time		06/03/2022 10:56:00 AM Eastern Daylight Time			06/03/2022 11:52:12 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Value Plus (PDP)	10	29					S2893	001	0	2023	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						06/02/2022	2023.01	06/02/2022 03:16:59 PM Eastern Daylight Time		06/03/2022 10:56:00 AM Eastern Daylight Time			06/03/2022 12:18:16 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Premier (PDP)	10	29					S2893	003	0	2023	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						04/25/2022	2023.01	04/25/2022 11:47:59 AM Eastern Daylight Time					06/01/2022 10:20:35 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	801	0	2023	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						04/25/2022	2023.01	04/25/2022 11:56:51 AM Eastern Daylight Time					06/01/2022 10:31:12 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	802	0	2023	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	06/04/2022	2023.01	06/04/2022 10:46:29 AM US Mountain Standard Time		06/06/2022 08:09:23 AM US Mountain Standard Time			06/06/2022 08:23:53 AM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Rx	www.BannerHealth.com/MedicareRx	Banner Medicare Simple Rx (PDP)	10	29					S3147	001	0	2023	Arizona		2					2									www.BannerHealth.com/MedicareRx	www.BannerHealth.com/MedicareRx										(844)549-1859		(602)462-0830		(844)556-7685		(602)755-4192										(711)-		(711)-		(711)-		(711)-																
S3147	002	0		29	10	S3147_002_0	5	1					1	06/04/2022	2023.01	06/04/2022 10:47:06 AM US Mountain Standard Time		06/03/2022 02:51:58 PM US Mountain Standard Time			06/06/2022 08:23:53 AM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Rx	www.BannerHealth.com/MedicareRx	Banner Medicare Classic Rx (PDP)	10	29					S3147	002	0	2023	Arizona		2					2									www.BannerHealth.com/MedicareRx	www.BannerHealth.com/MedicareRx										(844)549-1859		(602)462-0830		(844)556-7685		(602)755-4192										(711)-		(711)-		(711)-		(711)-																
S3147	003	0		29	10	S3147_003_0	5	1					1	06/04/2022	2023.01	06/04/2022 10:47:54 AM US Mountain Standard Time		06/03/2022 02:51:58 PM US Mountain Standard Time			06/06/2022 08:23:53 AM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Rx	www.BannerHealth.com/MedicareRx	Banner Medicare Premier Rx (PDP)	10	29					S3147	003	0	2023	Arizona		2					2									www.BannerHealth.com/MedicareRx	www.BannerHealth.com/MedicareRx										(844)549-1859		(602)462-0830		(844)556-7685		(602)755-4192										(711)-		(711)-		(711)-		(711)-																
S3285	801	0		29	10	S3285_801_0	1	1						05/23/2022	2023.01	05/23/2022 01:02:58 PM Pacific Daylight Time					05/23/2022 01:03:43 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	801	0	2023	VibrantRx - National		1					2									https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	802	0		29	10	S3285_802_0	1	1						05/23/2022	2023.01	05/23/2022 12:32:32 PM Pacific Daylight Time					05/23/2022 01:03:43 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	802	0	2023	VibrantRx - National		1					2									https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	803	0		29	10	S3285_803_0	1	1						05/23/2022	2023.01	05/23/2022 12:33:02 PM Pacific Daylight Time					05/23/2022 01:03:43 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	803	0	2023	VibrantRx - National		1					2									https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	804	0		29	10	S3285_804_0	1	1						05/23/2022	2023.01	05/23/2022 12:33:23 PM Pacific Daylight Time					05/23/2022 01:03:43 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	804	0	2023	VibrantRx - National		1					2									https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	805	0		29	10	S3285_805_0	1	1						05/23/2022	2023.01	05/23/2022 12:33:50 PM Pacific Daylight Time					05/23/2022 01:03:43 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	805	0	2023	VibrantRx - National		1					2									https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	806	0		29	10	S3285_806_0	1	1						05/23/2022	2023.01	05/23/2022 12:34:16 PM Pacific Daylight Time					05/23/2022 01:03:43 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	806	0	2023	VibrantRx - National		1					2									https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	807	0		29	10	S3285_807_0	1	1						05/23/2022	2023.01	05/23/2022 12:34:38 PM Pacific Daylight Time					05/23/2022 01:03:43 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	807	0	2023	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	3	1						06/15/2022	2023.01	06/15/2022 10:13:30 AM Eastern Daylight Time		07/11/2022 03:03:54 PM Eastern Daylight Time			07/15/2022 01:08:23 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	2023	New York		2					2									https://shop.bluerxny.com/medicare	https://shop.bluerxny.com/medicare										(833)409-1209		(833)409-1209		(855)523-0689		(855)523-0689										(711)-		(711)-		(711)-		(711)-																
S3375	002	0		29	10	S3375_002_0	4	1					1	07/15/2022	2023.01	07/15/2022 12:28:06 PM Eastern Daylight Time		07/11/2022 03:05:10 PM Eastern Daylight Time			07/15/2022 01:08:23 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	2023	New York		2					2									https://shop.bluerxny.com/medicare	https://shop.bluerxny.com/medicare										(833)409-1209		(833)409-1209		(855)523-0689		(855)523-0689										(711)-		(711)-		(711)-		(711)-																
S3389	802	0		29	10	S3389_802_0	4	1						05/04/2022	2023.01	05/04/2022 10:59:56 AM Eastern Daylight Time					06/05/2022 06:30:44 PM Eastern Daylight Time	UPMC HEALTH BENEFITS, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	802	0	2023	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	4	1						05/27/2022	2023.01	05/27/2022 09:36:54 AM Eastern Daylight Time					06/05/2022 06:30:44 PM Eastern Daylight Time	UPMC HEALTH BENEFITS, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	803	0	2023	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						04/11/2022	2023.01	04/11/2022 05:05:33 PM Eastern Daylight Time					06/06/2022 03:15:28 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	2023	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						05/24/2022	2023.01	05/24/2022 11:13:05 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	802	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						05/24/2022	2023.01	05/24/2022 11:13:19 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	803	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						05/24/2022	2023.01	05/24/2022 11:05:41 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	804	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						05/24/2022	2023.01	05/24/2022 11:06:50 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	805	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						05/24/2022	2023.01	05/24/2022 11:12:43 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	806	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						05/24/2022	2023.01	05/24/2022 11:14:44 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	807	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						05/24/2022	2023.01	05/24/2022 11:15:10 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	808	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						05/24/2022	2023.01	05/24/2022 11:15:37 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	809	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						05/24/2022	2023.01	05/24/2022 11:14:19 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	810	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						05/24/2022	2023.01	05/24/2022 11:13:53 AM Mountain Daylight Time					05/24/2022 11:22:18 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	https://mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	811	0	2023	Granite Alliance National EGWP		1					2									https://mygraniterx.com/Pharmacy-Locator	https://mygraniterx.com/Formulary-(Drug-List)										(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						04/08/2022	2023.01	04/08/2022 04:14:09 PM Hawaiian Standard Time					06/02/2022 07:28:17 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	2023	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						04/08/2022	2023.01	04/08/2022 04:14:35 PM Hawaiian Standard Time					06/02/2022 07:30:40 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	2023	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	2	1						04/27/2022	2023.01	04/27/2022 09:17:31 AM Central Daylight Time					06/03/2022 08:40:08 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medicare Prescription Plan	www.healthalliancemedicare.org	Health Alliance Group Medicare Prescription Plan (PDP)	10	29					S4219	801	0	2023	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	2	1						04/21/2022	2023.01	04/21/2022 10:18:40 AM Central Daylight Time					06/03/2022 08:40:08 AM Central 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	2023	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	2	1						05/31/2022	2023.01	05/31/2022 02:53:24 PM Eastern Daylight Time					06/06/2022 09:33:31 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-1 (PDP)	10	29					S4501	801	0	2023	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	2	1						05/31/2022	2023.01	05/31/2022 02:53:36 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	803	0		29	10	S4501_803_0	2	1						05/31/2022	2023.01	05/31/2022 02:53:43 PM Eastern Daylight Time					06/06/2022 09:33:31 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-3 (PDP)	10	29					S4501	803	0	2023	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	804	0		29	10	S4501_804_0	2	1						05/31/2022	2023.01	05/31/2022 02:53:48 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	805	0		29	10	S4501_805_0	2	1						05/31/2022	2023.01	05/31/2022 02:53:56 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	806	0		29	10	S4501_806_0	2	1						05/31/2022	2023.01	05/31/2022 02:54:04 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	807	0		29	10	S4501_807_0	2	1						05/31/2022	2023.01	05/31/2022 02:54:12 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	808	0		29	10	S4501_808_0	2	1						05/31/2022	2023.01	05/31/2022 02:54:19 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	809	0		29	10	S4501_809_0	2	1						05/31/2022	2023.01	05/31/2022 02:54:30 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	810	0		29	10	S4501_810_0	2	1						05/31/2022	2023.01	05/31/2022 02:54:37 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	811	0		29	10	S4501_811_0	2	1						05/31/2022	2023.01	05/31/2022 02:55:06 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	812	0		29	10	S4501_812_0	2	1						05/31/2022	2023.01	05/31/2022 02:55:13 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	813	0		29	10	S4501_813_0	2	1						05/31/2022	2023.01	05/31/2022 02:55:20 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	814	0		29	10	S4501_814_0	2	1						05/31/2022	2023.01	05/31/2022 02:55:27 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	815	0		29	10	S4501_815_0	2	1						05/31/2022	2023.01	05/31/2022 02:55:35 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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	816	0		29	10	S4501_816_0	2	1						05/31/2022	2023.01	05/31/2022 02:55:43 PM Eastern Daylight Time					06/06/2022 09:33:31 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	2023	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)-																
S4802	012	0		29	10	S4802_012_0	2	1						05/18/2022	2023.01	05/18/2022 04:59:07 PM Eastern Daylight Time		06/01/2022 11:07:41 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	012	0	2023	Louisiana		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	013	0		29	10	S4802_013_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:59 PM Eastern Daylight Time		06/01/2022 11:08:45 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	013	0	2023	Texas		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	014	0		29	10	S4802_014_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:53 PM Eastern Daylight Time		06/01/2022 11:09:50 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	014	0	2023	Oklahoma		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	020	0		29	10	S4802_020_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:47 PM Eastern Daylight Time		06/01/2022 11:10:54 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	020	0	2023	Oregon and Washington		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	021	0		29	10	S4802_021_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:41 PM Eastern Daylight Time		06/01/2022 11:11:59 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	021	0	2023	Idaho and Utah		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	069	0		29	10	S4802_069_0	3	1						05/27/2022	2023.01	05/27/2022 02:53:18 PM Eastern Daylight Time		07/21/2022 10:47:47 AM Central Daylight Time			07/26/2022 02:27:59 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	069	0	2023	Virginia		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	070	0		29	10	S4802_070_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:30 PM Eastern Daylight Time		06/01/2022 11:14:08 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	070	0	2023	South Carolina		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	071	0		29	10	S4802_071_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:24 PM Eastern Daylight Time		06/01/2022 11:15:12 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	071	0	2023	Alabama, Tennessee		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	072	0		29	10	S4802_072_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:18 PM Eastern Daylight Time		06/01/2022 11:16:17 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	072	0	2023	Missouri		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	073	0		29	10	S4802_073_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:11 PM Eastern Daylight Time		06/01/2022 11:17:21 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	073	0	2023	Arkansas		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	074	0		29	10	S4802_074_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:05 PM Eastern Daylight Time		06/01/2022 11:18:25 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	074	0	2023	Mississippi		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	075	0		29	10	S4802_075_0	2	1						05/18/2022	2023.01	05/18/2022 04:58:00 PM Eastern Daylight Time		06/01/2022 11:19:28 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	075	0	2023	Maine, New Hampshire		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	076	0		29	10	S4802_076_0	2	1						05/18/2022	2023.01	05/18/2022 04:57:51 PM Eastern Daylight Time		06/01/2022 11:20:32 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	076	0	2023	Connecticut, Massachusetts, Rhode Island, Vermont		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	077	0		29	10	S4802_077_0	2	1						05/18/2022	2023.01	05/18/2022 04:57:45 PM Eastern Daylight Time		06/01/2022 11:21:37 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	077	0	2023	New York		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	078	0		29	10	S4802_078_0	2	1						05/18/2022	2023.01	05/18/2022 04:57:40 PM Eastern Daylight Time		06/01/2022 11:22:41 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	078	0	2023	New Jersey		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	079	0		29	10	S4802_079_0	2	1						05/18/2022	2023.01	05/18/2022 04:57:33 PM Eastern Daylight Time		06/01/2022 11:23:46 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	079	0	2023	District of Columbia, Delaware, Maryland		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	080	0		29	10	S4802_080_0	2	1						05/18/2022	2023.01	05/18/2022 04:57:28 PM Eastern Daylight Time		06/01/2022 11:24:50 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	080	0	2023	Pennsylvania, West Virginia		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	081	0		29	10	S4802_081_0	2	1						05/18/2022	2023.01	05/18/2022 04:57:22 PM Eastern Daylight Time		06/01/2022 11:25:56 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	081	0	2023	North Carolina		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	082	0		29	10	S4802_082_0	2	1						05/18/2022	2023.01	05/18/2022 04:57:15 PM Eastern Daylight Time		06/01/2022 11:27:02 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	082	0	2023	Georgia		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	083	0		29	10	S4802_083_0	3	1						05/18/2022	2023.01	05/18/2022 04:57:08 PM Eastern Daylight Time		07/21/2022 10:48:52 AM Central Daylight Time			07/26/2022 02:27:59 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	083	0	2023	Florida		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	084	0		29	10	S4802_084_0	2	1						05/18/2022	2023.01	05/18/2022 04:57:01 PM Eastern Daylight Time		06/01/2022 11:29:11 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	084	0	2023	Michigan		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	085	0		29	10	S4802_085_0	2	1						05/18/2022	2023.01	05/18/2022 04:56:55 PM Eastern Daylight Time		06/01/2022 11:30:15 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	085	0	2023	Ohio		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	086	0		29	10	S4802_086_0	2	1						05/18/2022	2023.01	05/18/2022 04:56:49 PM Eastern Daylight Time		06/01/2022 11:31:19 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	086	0	2023	Indiana, Kentucky		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	087	0		29	10	S4802_087_0	2	1						05/18/2022	2023.01	05/18/2022 04:56:43 PM Eastern Daylight Time		06/01/2022 11:32:23 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	087	0	2023	Illinois		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	088	0		29	10	S4802_088_0	2	1						05/18/2022	2023.01	05/18/2022 04:56:37 PM Eastern Daylight Time		06/01/2022 11:33:27 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	088	0	2023	Kansas		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	089	0		29	10	S4802_089_0	3	1						05/18/2022	2023.01	05/18/2022 04:56:31 PM Eastern Daylight Time		07/21/2022 10:49:58 AM Central Daylight Time			07/26/2022 02:27:59 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	089	0	2023	IA, MN, MT, NE, ND, SD, WY		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	090	0		29	10	S4802_090_0	2	1						05/18/2022	2023.01	05/18/2022 04:56:25 PM Eastern Daylight Time		06/01/2022 11:35:34 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	090	0	2023	New Mexico		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	091	0		29	10	S4802_091_0	2	1						05/18/2022	2023.01	05/18/2022 04:56:19 PM Eastern Daylight Time		06/01/2022 11:36:43 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	091	0	2023	Colorado		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	092	0		29	10	S4802_092_0	3	1						05/18/2022	2023.01	05/18/2022 04:56:12 PM Eastern Daylight Time		07/21/2022 10:51:03 AM Central Daylight Time			07/26/2022 02:27:59 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	092	0	2023	Arizona		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	093	0		29	10	S4802_093_0	2	1						05/18/2022	2023.01	05/18/2022 04:56:06 PM Eastern Daylight Time		06/01/2022 11:38:51 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	093	0	2023	Nevada		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	094	0		29	10	S4802_094_0	2	1						05/18/2022	2023.01	05/18/2022 04:56:00 PM Eastern Daylight Time		06/01/2022 11:39:55 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	094	0	2023	California		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	095	0		29	10	S4802_095_0	2	1						05/18/2022	2023.01	05/18/2022 04:55:54 PM Eastern Daylight Time		06/01/2022 11:40:59 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	095	0	2023	Hawaii		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	096	0		29	10	S4802_096_0	2	1						05/18/2022	2023.01	05/18/2022 04:55:48 PM Eastern Daylight Time		06/01/2022 11:42:02 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	096	0	2023	Alaska		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	097	0		29	10	S4802_097_0	2	1						05/18/2022	2023.01	05/18/2022 04:55:42 PM Eastern Daylight Time		06/01/2022 11:43:06 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	097	0	2023	Wisconsin		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	132	0		29	10	S4802_132_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:55:37 PM Eastern Daylight Time		06/01/2022 11:44:11 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	132	0	2023	Wisconsin		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	133	0		29	10	S4802_133_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:55:31 PM Eastern Daylight Time		06/01/2022 11:45:14 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	133	0	2023	Louisiana		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	134	0		29	10	S4802_134_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:55:25 PM Eastern Daylight Time		06/01/2022 11:46:17 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	134	0	2023	Arizona		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	135	0		29	10	S4802_135_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:55:19 PM Eastern Daylight Time		06/01/2022 11:47:21 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	135	0	2023	Oregon, Washington		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	136	0		29	10	S4802_136_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:55:13 PM Eastern Daylight Time		06/01/2022 11:48:24 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	136	0	2023	Maine, New Hampshire		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	137	0		29	10	S4802_137_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:55:07 PM Eastern Daylight Time		06/01/2022 11:49:29 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	137	0	2023	Connecticut, Massachusetts, Rhode Island, Vermont		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	138	0		29	10	S4802_138_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:55:01 PM Eastern Daylight Time		06/01/2022 11:50:33 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	138	0	2023	New York		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	139	0		29	10	S4802_139_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:55 PM Eastern Daylight Time		06/01/2022 11:51:36 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	139	0	2023	New Jersey		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	140	0		29	10	S4802_140_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:49 PM Eastern Daylight Time		06/01/2022 11:52:39 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	140	0	2023	District of Columbia, Delaware, Maryland		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	141	0		29	10	S4802_141_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:43 PM Eastern Daylight Time		06/01/2022 11:53:42 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	141	0	2023	Pennsylvania, West Virginia		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	142	0		29	10	S4802_142_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:37 PM Eastern Daylight Time		06/01/2022 11:54:46 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	142	0	2023	Virginia		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	143	0		29	10	S4802_143_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:31 PM Eastern Daylight Time		06/01/2022 11:55:49 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	143	0	2023	North Carolina		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	144	0		29	10	S4802_144_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:24 PM Eastern Daylight Time		06/01/2022 11:56:52 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	144	0	2023	South Carolina		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	145	0		29	10	S4802_145_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:18 PM Eastern Daylight Time		06/01/2022 11:57:55 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	145	0	2023	Georgia		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	146	0		29	10	S4802_146_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:12 PM Eastern Daylight Time		06/01/2022 11:58:58 PM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	146	0	2023	Florida		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	147	0		29	10	S4802_147_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:07 PM Eastern Daylight Time		06/02/2022 12:00:01 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	147	0	2023	Alabama, Tennessee		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	148	0		29	10	S4802_148_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:54:01 PM Eastern Daylight Time		06/02/2022 12:01:05 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	148	0	2023	Michigan		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	149	0		29	10	S4802_149_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:53:55 PM Eastern Daylight Time		06/02/2022 12:02:10 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	149	0	2023	Ohio		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	150	0		29	10	S4802_150_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:53:49 PM Eastern Daylight Time		06/02/2022 12:03:13 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	150	0	2023	Indiana, Kentucky		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	151	0		29	10	S4802_151_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:53:42 PM Eastern Daylight Time		06/02/2022 12:04:16 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	151	0	2023	Illinois		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	152	0		29	10	S4802_152_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:53:36 PM Eastern Daylight Time		06/02/2022 12:05:19 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	152	0	2023	Missouri		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	153	0		29	10	S4802_153_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:53:29 PM Eastern Daylight Time		06/02/2022 12:06:22 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	153	0	2023	Arkansas		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	154	0		29	10	S4802_154_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:53:22 PM Eastern Daylight Time		06/02/2022 12:07:27 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	154	0	2023	Mississippi		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	155	0		29	10	S4802_155_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:53:16 PM Eastern Daylight Time		06/02/2022 12:08:31 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	155	0	2023	Texas		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	156	0		29	10	S4802_156_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:53:06 PM Eastern Daylight Time		06/02/2022 12:09:35 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	156	0	2023	Oklahoma		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	157	0		29	10	S4802_157_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:52:59 PM Eastern Daylight Time		06/02/2022 12:10:39 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	157	0	2023	Kansas		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	158	0		29	10	S4802_158_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:52:49 PM Eastern Daylight Time		06/02/2022 12:11:43 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	158	0	2023	IA, MN, MT, ND, NE, SD, WY		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	159	0		29	10	S4802_159_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:52:43 PM Eastern Daylight Time		06/02/2022 12:12:47 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	159	0	2023	New Mexico		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	160	0		29	10	S4802_160_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:52:36 PM Eastern Daylight Time		06/02/2022 12:13:51 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	160	0	2023	Colorado		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	161	0		29	10	S4802_161_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:52:30 PM Eastern Daylight Time		06/02/2022 12:14:53 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	161	0	2023	Nevada		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	162	0		29	10	S4802_162_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:52:23 PM Eastern Daylight Time		06/02/2022 12:15:57 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	162	0	2023	Idaho, Utah		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	163	0		29	10	S4802_163_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:52:16 PM Eastern Daylight Time		06/02/2022 12:17:01 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	163	0	2023	California		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	164	0		29	10	S4802_164_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:52:10 PM Eastern Daylight Time		06/02/2022 12:18:05 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	164	0	2023	Hawaii		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	165	0		29	10	S4802_165_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:52:04 PM Eastern Daylight Time		06/02/2022 12:19:09 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	165	0	2023	Alaska		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	204	0		29	10	S4802_204_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:58 PM Eastern Daylight Time		06/02/2022 12:20:12 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	204	0	2023	Northern New England (NH, ME)		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	205	0		29	10	S4802_205_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:52 PM Eastern Daylight Time		06/02/2022 12:21:15 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	205	0	2023	Central New England (CT, RI, MA, VT)		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	206	0		29	10	S4802_206_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:46 PM Eastern Daylight Time		06/02/2022 12:22:18 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	206	0	2023	New York		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	207	0		29	10	S4802_207_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:38 PM Eastern Daylight Time		06/02/2022 12:23:21 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	207	0	2023	New Jersey		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	208	0		29	10	S4802_208_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:32 PM Eastern Daylight Time		06/02/2022 12:24:24 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	208	0	2023	Mid-Atlantic (DE, DC, MD)		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	209	0		29	10	S4802_209_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:25 PM Eastern Daylight Time		06/02/2022 12:25:28 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	209	0	2023	Pennsylvania, West Virginia		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	210	0		29	10	S4802_210_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:19 PM Eastern Daylight Time		06/02/2022 12:26:31 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	210	0	2023	Virginia		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	211	0		29	10	S4802_211_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:12 PM Eastern Daylight Time		06/02/2022 12:27:34 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	211	0	2023	North Carolina		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	212	0		29	10	S4802_212_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:06 PM Eastern Daylight Time		06/02/2022 12:28:37 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	212	0	2023	South Carolina		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	213	0		29	10	S4802_213_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:51:00 PM Eastern Daylight Time		06/02/2022 12:29:41 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	213	0	2023	Georgia		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	214	0		29	10	S4802_214_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:50:53 PM Eastern Daylight Time		06/02/2022 12:30:42 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	214	0	2023	Florida		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	215	0		29	10	S4802_215_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:50:47 PM Eastern Daylight Time		06/02/2022 12:31:45 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	215	0	2023	Alabama, Tennessee		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	216	0		29	10	S4802_216_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:50:41 PM Eastern Daylight Time		06/02/2022 12:32:49 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	216	0	2023	Michigan		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	217	0		29	10	S4802_217_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:50:36 PM Eastern Daylight Time		06/02/2022 12:33:52 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	217	0	2023	Ohio		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	218	0		29	10	S4802_218_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:50:30 PM Eastern Daylight Time		06/02/2022 12:34:55 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	218	0	2023	Indiana, Kentucky		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	219	0		29	10	S4802_219_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:50:24 PM Eastern Daylight Time		06/02/2022 12:35:58 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	219	0	2023	Wisconsin		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	220	0		29	10	S4802_220_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:50:18 PM Eastern Daylight Time		06/02/2022 12:37:01 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	220	0	2023	Illinois		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	221	0		29	10	S4802_221_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:50:12 PM Eastern Daylight Time		06/02/2022 12:38:04 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	221	0	2023	Missouri		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	222	0		29	10	S4802_222_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:50:06 PM Eastern Daylight Time		06/02/2022 12:39:07 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	222	0	2023	Arkansas		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	223	0		29	10	S4802_223_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:49:16 PM Eastern Daylight Time		06/02/2022 12:40:10 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	223	0	2023	Mississippi		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	224	0		29	10	S4802_224_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:49:10 PM Eastern Daylight Time		06/02/2022 12:41:14 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	224	0	2023	Louisiana		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	225	0		29	10	S4802_225_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:49:04 PM Eastern Daylight Time		06/02/2022 12:42:18 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	225	0	2023	Texas		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	226	0		29	10	S4802_226_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:59 PM Eastern Daylight Time		06/02/2022 12:43:21 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	226	0	2023	Oklahoma		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	227	0		29	10	S4802_227_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:50 PM Eastern Daylight Time		06/02/2022 12:44:25 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	227	0	2023	Kansas		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	228	0		29	10	S4802_228_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:43 PM Eastern Daylight Time		06/02/2022 12:45:30 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	228	0	2023	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		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	229	0		29	10	S4802_229_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:37 PM Eastern Daylight Time		06/02/2022 12:46:35 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	229	0	2023	New Mexico		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	230	0		29	10	S4802_230_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:30 PM Eastern Daylight Time		06/02/2022 12:47:39 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	230	0	2023	Colorado		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	231	0		29	10	S4802_231_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:24 PM Eastern Daylight Time		06/02/2022 12:48:43 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	231	0	2023	Arizona		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	232	0		29	10	S4802_232_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:18 PM Eastern Daylight Time		06/02/2022 12:49:47 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	232	0	2023	Nevada		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	233	0		29	10	S4802_233_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:13 PM Eastern Daylight Time		06/02/2022 12:50:51 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	233	0	2023	Oregon, Washington		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	234	0		29	10	S4802_234_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:07 PM Eastern Daylight Time		06/02/2022 12:51:55 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	234	0	2023	Idaho, Utah		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	235	0		29	10	S4802_235_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:48:00 PM Eastern Daylight Time		06/02/2022 12:52:59 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	235	0	2023	California		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	236	0		29	10	S4802_236_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:47:54 PM Eastern Daylight Time		06/02/2022 12:54:03 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	236	0	2023	Hawaii		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S4802	237	0		29	10	S4802_237_0	2	1					1	05/18/2022	2023.01	05/18/2022 04:47:48 PM Eastern Daylight Time		06/02/2022 12:55:07 AM Eastern Daylight Time			06/04/2022 05:49:23 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	Wellcare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	237	0	2023	Alaska		2					2									www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(866)859-9084		(866)859-9084										(711)-		(711)-		(711)-		(711)-																
S5450	801	0		29	10	S5450_801_0	1	1						05/16/2022	2023.01	05/16/2022 03:59:40 PM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	801	0	2023	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						05/16/2022	2023.01	05/16/2022 03:59:59 PM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	802	0	2023	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						05/16/2022	2023.01	05/16/2022 04:00:06 PM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	803	0	2023	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						05/16/2022	2023.01	05/16/2022 04:00:17 PM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	804	0	2023	38 PDP Regions		1					2									bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	805	0		29	10	S5450_805_0	1	1						05/16/2022	2023.01	05/16/2022 04:00:26 PM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	805	0	2023	38 PDP Regions		1					2									bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	806	0		29	10	S5450_806_0	1	1						05/16/2022	2023.01	05/16/2022 04:00:34 PM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	806	0	2023	38 PDP Regions		1					2									bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	807	0		29	10	S5450_807_0	1	1						05/16/2022	2023.01	05/16/2022 04:00:42 PM Eastern Daylight Time					06/04/2022 01:26:40 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	807	0	2023	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	5	1						05/26/2022	2023.01	05/26/2022 12:18:44 PM Central Daylight Time		06/02/2022 08:31:04 AM Eastern Daylight Time			06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx Standard (PDP)	10	29					S5540	002	0	2023	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		(866)760-3711		(866)760-3711										(711)-		(711)-		(711)-		(711)-																
S5540	004	0		29	10	S5540_004_0	5	1						05/26/2022	2023.01	05/26/2022 12:19:46 PM Central Daylight Time		06/02/2022 08:31:29 AM Eastern Daylight Time			06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx Enhanced (PDP)	10	29					S5540	004	0	2023	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		(866)760-3711		(866)760-3711										(711)-		(711)-		(711)-		(711)-																
S5540	803	0		29	10	S5540_803_0	3	1						05/06/2022	2023.01	05/06/2022 03:13:19 PM Central Daylight Time					06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx EGWP Complete (PDP)	10	29					S5540	803	0	2023	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		(866)760-3711		(866)760-3711										(711)-		(711)-		(711)-		(711)-																
S5540	804	0		29	10	S5540_804_0	3	1						05/06/2022	2023.01	05/06/2022 03:13:31 PM Central Daylight Time					06/06/2022 11:34:31 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx EGWP HCE COE (PDP)	10	29					S5540	804	0	2023	NC Employer Groups		1					2									https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare										(888)247-4142		(888)247-4142		(888)247-4142		(888)247-4142										(711)-		(711)-		(711)-		(711)-																
S5552	004	0		29	10	S5552_004_0	1	1						05/28/2022	2023.01	05/28/2022 08:45:42 AM Eastern Daylight Time		05/31/2022 11:53:30 AM Eastern Daylight Time			06/02/2022 10:16:57 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	2023	State of New York		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5552	005	0		29	10	S5552_005_0	3	1					1	05/28/2022	2023.01	05/28/2022 08:46:53 AM Eastern Daylight Time		07/14/2022 11:51:56 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5552	005	0	2023	State of New York		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 08:48:06 AM Eastern Daylight Time		05/31/2022 11:54:20 AM Eastern Daylight Time			06/02/2022 10:16:57 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	2023	State of New York		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	4	1						05/20/2022	2023.01	05/20/2022 12:14:16 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S5552	801	0	2023	State of New York		1					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	3	1						05/31/2022	2023.01	05/31/2022 05:09:33 PM Eastern Daylight Time		06/05/2022 06:34:57 PM Eastern Daylight Time			06/06/2022 10:37:43 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	2023	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	3	1						05/31/2022	2023.01	05/31/2022 05:10:50 PM Eastern Daylight Time		06/05/2022 06:35:01 PM Eastern Daylight Time			06/06/2022 10:37:43 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	2023	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	3	1						05/08/2022	2023.01	05/08/2022 02:47:03 PM Eastern Daylight Time					06/06/2022 10:37:43 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	2023	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	3	1						05/07/2022	2023.01	05/07/2022 11:17:14 PM Eastern Daylight Time					06/06/2022 10:37:43 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	2023	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						05/26/2022	2023.01	05/26/2022 12:13:02 PM Eastern Daylight Time					05/31/2022 11:16:35 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	2023	Paramount Standard Prescription Drug Plan (Ohio)		1					2									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																
S5588	803	0		29	10	S5588_803_0	1	1						05/26/2022	2023.01	05/26/2022 12:13:52 PM Eastern Daylight Time					05/31/2022 11:16:35 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	2023	Paramount Enhanced Prescription Drug Plan (Ohio)		1					2									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																
S5593	002	0		29	10	S5593_002_0	7	1						06/02/2022	2023.01	06/02/2022 11:41:20 AM Eastern Daylight Time		07/22/2022 12:32:44 PM Eastern Daylight Time			07/26/2022 01:26:18 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Plus (PDP)	10	29					S5593	002	0	2023	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	7	1						06/02/2022	2023.01	06/02/2022 11:40:58 AM Eastern Daylight Time		07/22/2022 12:33:24 PM Eastern Daylight Time			07/26/2022 01:26:18 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Complete (PDP)	10	29					S5593	003	0	2023	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	3	1						05/16/2022	2023.01	05/16/2022 02:33:27 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	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	3	1						04/14/2022	2023.01	04/14/2022 01:28:46 PM Eastern Daylight Time					06/03/2022 06:57:37 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	2023	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	807	0		29	10	S5593_807_0	3	1						05/16/2022	2023.01	05/16/2022 02:33:44 PM Eastern Daylight Time					06/03/2022 06:57:37 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP ASO 1 CALENDAR (PDP)	10	29					S5593	807	0	2023	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	808	0		29	10	S5593_808_0	3	1						05/10/2022	2023.01	05/10/2022 11:09:13 AM Eastern Daylight Time					06/03/2022 06:57:37 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP ASO 2 CALENDAR (PDP)	10	29					S5593	808	0	2023	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	06/06/2022	2023.01	06/06/2022 05:38:52 PM Eastern Daylight Time		07/11/2022 03:06:43 PM Eastern Daylight Time			07/15/2022 01:08:23 PM 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	2023	Maine and New Hampshire		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	005	0		29	10	S5596_005_0	3	1						06/06/2022	2023.01	06/06/2022 05:40:22 PM Eastern Daylight Time		07/11/2022 03:02:22 PM Eastern Daylight Time			07/15/2022 01:08:23 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	2023	Virginia		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	006	0		29	10	S5596_006_0	3	1					1	06/06/2022	2023.01	06/06/2022 05:41:37 PM Eastern Daylight Time		07/11/2022 03:03:37 PM Eastern Daylight Time			07/15/2022 01:08:23 PM 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	2023	Virginia		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	013	0		29	10	S5596_013_0	3	1						06/06/2022	2023.01	06/06/2022 05:42:47 PM Eastern Daylight Time		07/11/2022 03:04:53 PM Eastern Daylight Time			07/15/2022 01:08:23 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	2023	Ohio		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	014	0		29	10	S5596_014_0	3	1					1	06/06/2022	2023.01	06/06/2022 05:44:08 PM Eastern Daylight Time		07/11/2022 03:06:09 PM Eastern Daylight Time			07/15/2022 01:08:23 PM 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	2023	Ohio		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	017	0		29	10	S5596_017_0	4	1						06/06/2022	2023.01	06/06/2022 05:45:18 PM Eastern Daylight Time		07/18/2022 02:54:28 PM Eastern Daylight Time			07/19/2022 10:52:59 AM 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	2023	Indiana and Kentucky		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	018	0		29	10	S5596_018_0	3	1					1	06/06/2022	2023.01	06/06/2022 05:47:03 PM Eastern Daylight Time		07/11/2022 03:07:25 PM Eastern Daylight Time			07/15/2022 01:08:23 PM 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	2023	Indiana and Kentucky		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	043	0		29	10	S5596_043_0	4	1						06/06/2022	2023.01	06/06/2022 05:49:02 PM Eastern Daylight Time		07/18/2022 03:02:30 PM Eastern Daylight Time			07/19/2022 10:52:59 AM 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	2023	Missouri		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	044	0		29	10	S5596_044_0	4	1					1	06/06/2022	2023.01	06/06/2022 05:52:03 PM Eastern Daylight Time		07/18/2022 03:03:49 PM Eastern Daylight Time			07/19/2022 10:52:59 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	2023	Missouri		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	046	0		29	10	S5596_046_0	3	1						06/06/2022	2023.01	06/06/2022 05:54:07 PM Eastern Daylight Time		07/11/2022 03:11:23 PM Eastern Daylight Time			07/15/2022 01:08:23 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	2023	Maine and New Hampshire		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	056	0		29	10	S5596_056_0	3	1						06/06/2022	2023.01	06/06/2022 05:55:20 PM Eastern Daylight Time		07/11/2022 03:09:58 PM Eastern Daylight Time			07/15/2022 01:08:23 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	2023	Wisconsin		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	057	0		29	10	S5596_057_0	3	1					1	06/06/2022	2023.01	06/06/2022 05:56:33 PM Eastern Daylight Time		07/11/2022 03:12:57 PM Eastern Daylight Time			07/15/2022 01:08:23 PM 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	2023	Wisconsin		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	059	0		29	10	S5596_059_0	4	1						06/06/2022	2023.01	06/06/2022 05:58:20 PM Eastern Daylight Time		07/18/2022 03:05:10 PM Eastern Daylight Time			07/19/2022 10:52:59 AM 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	2023	Colorado		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	060	0		29	10	S5596_060_0	3	1					1	06/06/2022	2023.01	06/06/2022 05:59:38 PM Eastern Daylight Time		07/11/2022 03:14:31 PM Eastern Daylight Time			07/15/2022 01:08:23 PM 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	2023	Colorado		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	062	0		29	10	S5596_062_0	4	1						06/06/2022	2023.01	06/06/2022 06:00:59 PM Eastern Daylight Time		07/18/2022 03:06:32 PM Eastern Daylight Time			07/19/2022 10:52:59 AM 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	2023	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	3	1					1	06/06/2022	2023.01	06/06/2022 06:02:23 PM Eastern Daylight Time		07/11/2022 03:12:25 PM Eastern Daylight Time			07/15/2022 01:08:23 PM 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	2023	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	085	0		29	10	S5596_085_0	4	1						06/06/2022	2023.01	06/06/2022 06:03:30 PM Eastern Daylight Time		07/18/2022 03:07:52 PM Eastern Daylight Time			07/19/2022 10:52:59 AM 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	2023	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	06/06/2022	2023.01	06/06/2022 06:04:56 PM Eastern Daylight Time		07/11/2022 03:15:03 PM Eastern Daylight Time			07/15/2022 01:08:23 PM 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	2023	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						06/06/2022	2023.01	06/06/2022 06:05:59 PM Eastern Daylight Time		07/11/2022 03:16:15 PM Eastern Daylight Time			07/15/2022 01:08:23 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	2023	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	06/06/2022	2023.01	06/06/2022 06:07:16 PM Eastern Daylight Time		07/11/2022 03:17:28 PM Eastern Daylight Time			07/15/2022 01:08:23 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 Plus (PDP)	10	29					S5596	088	0	2023	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	2	1						04/21/2022	2023.01	04/21/2022 09:45:49 AM Eastern Daylight Time					06/02/2022 02:24:39 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	2023	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										(833)279-0466		(833)279-0466		(833)285-4636		(833)285-4636										(711)-		(711)-		(711)-		(711)-																
S5596	804	0		29	10	S5596_804_0	2	1						04/21/2022	2023.01	04/21/2022 09:45:52 AM Eastern Daylight Time					06/02/2022 02:24:39 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	2023	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										(833)279-0466		(833)279-0466		(833)285-4636		(833)285-4636										(711)-		(711)-		(711)-		(711)-																
S5596	844	0		29	10	S5596_844_0	2	1						04/21/2022	2023.01	04/21/2022 09:45:57 AM Eastern Daylight Time					06/02/2022 02:24:39 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	2023	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	2	1						04/21/2022	2023.01	04/21/2022 09:46:01 AM Eastern Daylight Time					06/02/2022 02:24:39 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	2023	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	846	0		29	10	S5596_846_0	2	1						05/13/2022	2023.01	05/13/2022 04:05:40 PM Eastern Daylight Time					06/02/2022 02:24:39 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	846	0	2023	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	847	0		29	10	S5596_847_0	2	1						05/13/2022	2023.01	05/13/2022 04:05:48 PM Eastern Daylight Time					06/02/2022 02:24:39 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	847	0	2023	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	848	0		29	10	S5596_848_0	2	1						05/13/2022	2023.01	05/13/2022 04:06:09 PM Eastern Daylight Time					06/02/2022 02:24:39 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	848	0	2023	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	1	1						05/27/2022	2023.01	05/27/2022 12:45:52 PM Eastern Daylight Time		05/30/2022 11:37:42 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	002	0	2023	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	2	1					1	05/27/2022	2023.01	05/27/2022 11:39:03 AM Eastern Daylight Time		06/01/2022 05:12:34 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	003	0	2023	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	05/27/2022	2023.01	05/27/2022 12:47:48 PM Eastern Daylight Time		05/30/2022 11:38:32 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	004	0	2023	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	05/27/2022	2023.01	05/27/2022 11:36:50 AM Eastern Daylight Time		06/01/2022 05:13:00 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	005	0	2023	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	05/27/2022	2023.01	05/27/2022 12:48:51 PM Eastern Daylight Time		05/30/2022 11:39:22 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	006	0	2023	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	05/27/2022	2023.01	05/27/2022 11:41:45 AM Eastern Daylight Time		06/01/2022 05:13:26 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	007	0	2023	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	05/27/2022	2023.01	05/27/2022 12:49:46 PM Eastern Daylight Time		05/30/2022 11:40:12 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	008	0	2023	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	05/27/2022	2023.01	05/27/2022 12:35:09 PM Eastern Daylight Time		06/01/2022 05:13:54 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	009	0	2023	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	05/27/2022	2023.01	05/27/2022 12:41:46 PM Eastern Daylight Time		05/30/2022 11:41:04 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	010	0	2023	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	2	1					1	05/27/2022	2023.01	05/27/2022 12:47:03 PM Eastern Daylight Time		06/01/2022 05:14:21 PM Eastern Daylight Time			06/02/2022 03:27:54 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	011	0	2023	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	05/27/2022	2023.01	05/27/2022 12:51:59 PM Eastern Daylight Time		05/30/2022 11:41:54 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	012	0	2023	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	05/27/2022	2023.01	05/27/2022 12:51:47 PM Eastern Daylight Time		06/01/2022 05:14:50 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	013	0	2023	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	1	1					0	05/27/2022	2023.01	05/27/2022 12:53:13 PM Eastern Daylight Time		05/30/2022 11:42:44 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	014	0	2023	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	05/27/2022	2023.01	05/27/2022 12:56:51 PM Eastern Daylight Time		06/01/2022 05:15:18 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	015	0	2023	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	05/27/2022	2023.01	05/27/2022 12:54:42 PM Eastern Daylight Time		05/30/2022 11:43:32 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	016	0	2023	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	05/27/2022	2023.01	05/27/2022 12:59:47 PM Eastern Daylight Time		06/01/2022 05:15:44 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	017	0	2023	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	05/27/2022	2023.01	05/27/2022 12:56:08 PM Eastern Daylight Time		05/30/2022 11:44:22 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	018	0	2023	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	05/27/2022	2023.01	05/27/2022 01:04:11 PM Eastern Daylight Time		06/01/2022 05:16:10 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	019	0	2023	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	05/27/2022	2023.01	05/27/2022 12:57:18 PM Eastern Daylight Time		05/30/2022 11:45:20 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	020	0	2023	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	05/27/2022	2023.01	05/27/2022 01:07:36 PM Eastern Daylight Time		06/01/2022 05:16:36 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	021	0	2023	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	05/27/2022	2023.01	05/27/2022 12:58:20 PM Eastern Daylight Time		07/26/2022 10:28:18 AM Eastern Daylight Time			07/26/2022 03:12:53 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	022	0	2023	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	05/27/2022	2023.01	05/27/2022 01:10:31 PM Eastern Daylight Time		06/01/2022 05:17:02 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	023	0	2023	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	05/27/2022	2023.01	05/27/2022 12:59:09 PM Eastern Daylight Time		05/30/2022 11:47:30 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	024	0	2023	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	05/27/2022	2023.01	05/27/2022 01:14:55 PM Eastern Daylight Time		06/01/2022 05:17:26 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	025	0	2023	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	05/27/2022	2023.01	05/27/2022 01:01:11 PM Eastern Daylight Time		05/30/2022 11:48:24 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	026	0	2023	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	05/27/2022	2023.01	05/27/2022 01:19:14 PM Eastern Daylight Time		06/01/2022 05:17:52 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	027	0	2023	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	05/27/2022	2023.01	05/27/2022 01:02:20 PM Eastern Daylight Time		05/30/2022 11:49:18 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	028	0	2023	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	05/27/2022	2023.01	05/27/2022 01:23:45 PM Eastern Daylight Time		06/01/2022 05:18:20 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	029	0	2023	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	05/27/2022	2023.01	05/27/2022 01:03:23 PM Eastern Daylight Time		05/30/2022 11:50:10 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	030	0	2023	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	05/27/2022	2023.01	05/27/2022 01:29:21 PM Eastern Daylight Time		06/01/2022 05:18:46 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	031	0	2023	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	05/27/2022	2023.01	05/27/2022 01:05:46 PM Eastern Daylight Time		05/30/2022 11:51:04 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	032	0	2023	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	05/27/2022	2023.01	05/27/2022 01:32:10 PM Eastern Daylight Time		06/01/2022 05:19:10 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	033	0	2023	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	05/27/2022	2023.01	05/27/2022 01:06:53 PM Eastern Daylight Time		05/30/2022 11:51:58 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	034	0	2023	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	05/27/2022	2023.01	05/27/2022 01:34:49 PM Eastern Daylight Time		06/01/2022 05:19:38 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	035	0	2023	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	05/27/2022	2023.01	05/27/2022 01:07:57 PM Eastern Daylight Time		05/30/2022 11:52:52 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	036	0	2023	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	05/27/2022	2023.01	05/27/2022 01:39:46 PM Eastern Daylight Time		06/01/2022 05:20:04 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	037	0	2023	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	05/27/2022	2023.01	05/27/2022 01:09:03 PM Eastern Daylight Time		05/30/2022 11:53:46 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	038	0	2023	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	05/27/2022	2023.01	05/27/2022 01:10:19 PM Eastern Daylight Time		05/30/2022 11:54:12 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	040	0	2023	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	05/27/2022	2023.01	05/27/2022 01:42:17 PM Eastern Daylight Time		06/01/2022 05:20:30 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	041	0	2023	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	05/27/2022	2023.01	05/27/2022 01:11:18 PM Eastern Daylight Time		05/30/2022 11:55:06 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	042	0	2023	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	05/27/2022	2023.01	05/27/2022 01:12:27 PM Eastern Daylight Time		05/30/2022 11:55:32 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	044	0	2023	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	05/27/2022	2023.01	05/27/2022 01:45:06 PM Eastern Daylight Time		06/01/2022 05:20:58 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	045	0	2023	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	05/27/2022	2023.01	05/27/2022 01:13:36 PM Eastern Daylight Time		05/30/2022 11:56:28 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	046	0	2023	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	05/27/2022	2023.01	05/27/2022 01:14:42 PM Eastern Daylight Time		05/30/2022 11:56:56 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	048	0	2023	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	05/27/2022	2023.01	05/27/2022 01:47:53 PM Eastern Daylight Time		06/01/2022 05:21:24 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	049	0	2023	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	05/27/2022	2023.01	05/27/2022 12:44:33 PM Eastern Daylight Time		05/30/2022 11:57:50 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	050	0	2023	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	05/27/2022	2023.01	05/27/2022 01:50:37 PM Eastern Daylight Time		06/01/2022 05:21:52 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	051	0	2023	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	05/27/2022	2023.01	05/27/2022 12:46:40 PM Eastern Daylight Time		05/30/2022 11:58:40 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	052	0	2023	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	05/27/2022	2023.01	05/27/2022 01:53:38 PM Eastern Daylight Time		06/01/2022 05:22:18 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	053	0	2023	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	05/27/2022	2023.01	05/27/2022 12:48:45 PM Eastern Daylight Time		05/30/2022 11:59:30 AM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	054	0	2023	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	05/27/2022	2023.01	05/27/2022 01:56:42 PM Eastern Daylight Time		06/01/2022 05:22:44 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	055	0	2023	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	05/27/2022	2023.01	05/27/2022 12:50:38 PM Eastern Daylight Time		07/26/2022 10:28:42 AM Eastern Daylight Time			07/26/2022 03:12:53 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	056	0	2023	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	05/27/2022	2023.01	05/27/2022 12:52:44 PM Eastern Daylight Time		06/01/2022 05:23:12 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	057	0	2023	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	05/27/2022	2023.01	05/27/2022 12:55:06 PM Eastern Daylight Time		05/30/2022 12:01:38 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	058	0	2023	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	05/27/2022	2023.01	05/27/2022 12:57:28 PM Eastern Daylight Time		06/01/2022 05:23:38 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	059	0	2023	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	05/27/2022	2023.01	05/27/2022 12:59:37 PM Eastern Daylight Time		05/30/2022 12:02:32 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	060	0	2023	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	05/27/2022	2023.01	05/27/2022 01:02:13 PM Eastern Daylight Time		06/01/2022 05:24:06 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	061	0	2023	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	05/27/2022	2023.01	05/27/2022 01:05:52 PM Eastern Daylight Time		05/30/2022 12:03:24 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	062	0	2023	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	05/27/2022	2023.01	05/27/2022 01:08:10 PM Eastern Daylight Time		06/01/2022 05:24:32 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	063	0	2023	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	05/27/2022	2023.01	05/27/2022 01:10:34 PM Eastern Daylight Time		05/30/2022 12:04:14 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	064	0	2023	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	05/27/2022	2023.01	05/27/2022 01:12:31 PM Eastern Daylight Time		06/01/2022 05:24:58 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	065	0	2023	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	05/27/2022	2023.01	05/27/2022 01:15:14 PM Eastern Daylight Time		05/30/2022 12:05:04 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	066	0	2023	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	05/27/2022	2023.01	05/27/2022 01:21:02 PM Eastern Daylight Time		06/01/2022 05:25:26 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	067	0	2023	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	05/27/2022	2023.01	05/27/2022 01:24:31 PM Eastern Daylight Time		05/30/2022 12:05:56 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	068	0	2023	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	05/27/2022	2023.01	05/27/2022 01:26:21 PM Eastern Daylight Time		06/01/2022 05:25:52 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	107	0	2023	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	05/27/2022	2023.01	05/27/2022 01:29:18 PM Eastern Daylight Time		06/01/2022 05:26:22 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	108	0	2023	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	05/27/2022	2023.01	05/27/2022 01:32:09 PM Eastern Daylight Time		06/01/2022 05:26:48 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	109	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:18:15 AM Eastern Daylight Time		05/30/2022 12:07:36 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	176	0	2023	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					1	06/02/2022	2023.01	06/02/2022 10:22:58 AM Central Daylight Time		05/30/2022 12:08:02 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	177	0	2023	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					1	06/02/2022	2023.01	06/02/2022 10:23:22 AM Central Daylight Time		05/30/2022 12:08:26 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	178	0	2023	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					1	06/02/2022	2023.01	06/02/2022 10:23:47 AM Central Daylight Time		05/30/2022 12:08:54 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	179	0	2023	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					1	06/02/2022	2023.01	06/02/2022 10:24:10 AM Central Daylight Time		05/30/2022 12:09:18 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	180	0	2023	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					1	06/02/2022	2023.01	06/02/2022 10:24:51 AM Central Daylight Time		05/30/2022 12:09:44 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	181	0	2023	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					1	06/02/2022	2023.01	06/02/2022 10:25:13 AM Central Daylight Time		05/30/2022 12:10:10 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	182	0	2023	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					1	06/02/2022	2023.01	06/02/2022 10:25:36 AM Central Daylight Time		05/30/2022 12:10:34 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	183	0	2023	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					1	06/02/2022	2023.01	06/02/2022 10:26:05 AM Central Daylight Time		05/30/2022 12:11:00 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	184	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:19:15 AM Eastern Daylight Time		05/30/2022 12:11:26 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	185	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:19:51 AM Eastern Daylight Time		05/30/2022 12:11:52 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	186	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:20:28 AM Eastern Daylight Time		05/30/2022 12:12:18 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	187	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:20:58 AM Eastern Daylight Time		05/30/2022 12:12:44 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	188	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:50:24 AM Eastern Daylight Time		05/30/2022 12:13:10 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	189	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:22:11 AM Eastern Daylight Time		05/30/2022 12:13:34 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	190	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:22:56 AM Eastern Daylight Time		05/30/2022 12:14:00 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	191	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:23:38 AM Eastern Daylight Time		05/30/2022 12:14:26 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	192	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:27:39 AM Eastern Daylight Time		05/30/2022 12:14:52 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	193	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:28:00 AM Eastern Daylight Time		05/30/2022 12:15:20 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	194	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:28:16 AM Eastern Daylight Time		05/30/2022 12:15:46 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	195	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:28:31 AM Eastern Daylight Time		05/30/2022 12:16:12 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	196	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:29:18 AM Eastern Daylight Time		05/30/2022 12:16:40 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	197	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:29:38 AM Eastern Daylight Time		05/30/2022 12:17:06 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	198	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:29:54 AM Eastern Daylight Time		05/30/2022 12:17:32 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	199	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:30:09 AM Eastern Daylight Time		05/30/2022 12:17:58 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	200	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:41:13 AM Eastern Daylight Time		05/30/2022 12:18:24 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	201	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:22:17 AM Eastern Daylight Time		05/30/2022 12:18:50 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	202	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:22:49 AM Eastern Daylight Time		05/30/2022 12:19:16 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	203	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:23:21 AM Eastern Daylight Time		05/30/2022 12:19:40 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	204	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:23:51 AM Eastern Daylight Time		05/30/2022 12:20:06 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	205	0	2023	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	1	1					1	06/02/2022	2023.01	06/02/2022 11:24:20 AM Eastern Daylight Time		05/30/2022 12:20:32 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	206	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:24:48 AM Eastern Daylight Time		05/30/2022 12:20:58 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	207	0	2023	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	1	1					1	06/02/2022	2023.01	06/02/2022 11:25:21 AM Eastern Daylight Time		05/30/2022 12:21:24 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	208	0	2023	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					1	06/02/2022	2023.01	06/02/2022 11:25:52 AM Eastern Daylight Time		05/30/2022 12:21:50 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartSaver (PDP)	10	29					S5601	209	0	2023	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	1	1					1	05/27/2022	2023.01	05/27/2022 02:00:51 PM Eastern Daylight Time		06/01/2022 05:27:16 PM Eastern Daylight Time			06/02/2022 02:18:43 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	210	0	2023	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						05/27/2022	2023.01	05/27/2022 04:59:34 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group (PDP)	10	29					S5601	801	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	802	0		29	10	S5601_802_0	1	1						05/27/2022	2023.01	05/27/2022 05:00:17 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group (PDP)	10	29					S5601	802	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	803	0		29	10	S5601_803_0	1	1						05/27/2022	2023.01	05/27/2022 05:00:48 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group FI AET (PDP)	10	29					S5601	803	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	804	0		29	10	S5601_804_0	1	1						05/27/2022	2023.01	05/27/2022 05:01:16 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group FI (PDP)	10	29					S5601	804	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	805	0		29	10	S5601_805_0	1	1						05/27/2022	2023.01	05/27/2022 05:01:48 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	805	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	806	0		29	10	S5601_806_0	1	1						05/27/2022	2023.01	05/27/2022 05:02:30 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF AET (PDP)	10	29					S5601	806	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	807	0		29	10	S5601_807_0	1	1						05/27/2022	2023.01	05/27/2022 05:03:11 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	807	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	808	0		29	10	S5601_808_0	1	1						05/27/2022	2023.01	05/27/2022 05:03:44 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF - Non Calendar (PDP)	10	29					S5601	808	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	809	0		29	10	S5601_809_0	1	1						05/27/2022	2023.01	05/27/2022 05:04:16 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	809	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	810	0		29	10	S5601_810_0	1	1						05/27/2022	2023.01	05/27/2022 05:04:38 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF - Non Calendar (PDP)	10	29					S5601	810	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	811	0		29	10	S5601_811_0	1	1						05/27/2022	2023.01	05/27/2022 05:05:03 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group - State of NY (PDP)	10	29					S5601	811	0	2023	National		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	812	0		29	10	S5601_812_0	1	1						05/27/2022	2023.01	05/27/2022 05:05:27 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	812	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	813	0		29	10	S5601_813_0	1	1						05/27/2022	2023.01	05/27/2022 05:05:57 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	813	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	814	0		29	10	S5601_814_0	1	1						05/27/2022	2023.01	05/27/2022 05:06:26 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	814	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	815	0		29	10	S5601_815_0	1	1						05/27/2022	2023.01	05/27/2022 05:07:05 PM Central Daylight Time					05/27/2022 05:25:43 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	815	0	2023	National SilverScript Group		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	816	0		29	10	S5601_816_0	1	1						05/27/2022	2023.01	05/27/2022 05:07:50 PM Central Daylight Time					05/27/2022 05:25:43 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	2023	Employer National		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(855)222-6857		(855)222-6857		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	818	0		29	10	S5601_818_0	1	1						05/27/2022	2023.01	05/27/2022 05:08:19 PM Central Daylight Time					05/27/2022 05:25:43 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	2023	Employer National		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(855)222-6857		(855)222-6857		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5601	820	0		29	10	S5601_820_0	1	1						05/27/2022	2023.01	05/27/2022 05:08:46 PM Central Daylight Time					05/27/2022 05:25:43 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	2023	Employer National		1					2									www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(855)222-6857		(855)222-6857		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5609	001	0		29	10	S5609_001_0	5	1						05/20/2022	2023.01	05/20/2022 03:06:50 PM Pacific Daylight Time		06/01/2022 05:00:07 PM Pacific Daylight Time			06/03/2022 12:02:15 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Basic (PDP)	10	29					S5609	001	0	2023	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)-		(800)735-2900		(711)-																
S5609	002	0		29	10	S5609_002_0	5	1						05/20/2022	2023.01	05/20/2022 03:01:25 PM Pacific Daylight Time		06/01/2022 05:01:23 PM Pacific Daylight Time			06/03/2022 12:02:15 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Enhanced (PDP)	10	29					S5609	002	0	2023	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)-		(800)735-2900		(711)-																
S5609	802	0		29	10	S5609_802_0	1	1						05/06/2022	2023.01	05/06/2022 09:43:10 AM Pacific Daylight Time					05/17/2022 02:26:52 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script (PDP)	10	29					S5609	802	0	2023	Nationwide except territories		1					2									www.asuris.com/medicare	www.asuris.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5609	804	0		29	10	S5609_804_0	1	1						04/18/2022	2023.01	04/18/2022 10:07:20 AM Pacific Daylight Time					05/17/2022 02:26:52 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script 02 (PDP)	10	29					S5609	804	0	2023	Nationwide except Territories		1					2									www.asuris.com/medicare	www.asuris.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5609	805	0		29	10	S5609_805_0	1	1						04/18/2022	2023.01	04/18/2022 10:07:29 AM Pacific Daylight Time					05/17/2022 02:26:52 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script 03 (PDP)	10	29					S5609	805	0	2023	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	3	1						05/18/2022	2023.01	05/18/2022 01:47:57 PM Central Daylight Time		06/13/2022 08:25:54 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	003	0	2023	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	3	1						05/18/2022	2023.01	05/18/2022 01:48:03 PM Central Daylight Time		06/13/2022 08:26:21 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	008	0	2023	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	3	1						05/18/2022	2023.01	05/18/2022 10:56:09 AM Central Daylight Time		06/13/2022 08:26:48 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	013	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:26:17 PM Central Daylight Time		06/13/2022 08:27:15 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	018	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:26:03 PM Central Daylight Time		06/13/2022 08:27:42 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	053	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:25:48 PM Central Daylight Time		06/13/2022 08:28:08 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	068	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:25:35 PM Central Daylight Time		06/13/2022 08:28:35 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	088	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:25:16 PM Central Daylight Time		06/13/2022 08:29:02 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	103	0	2023	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	3	1						05/18/2022	2023.01	05/18/2022 10:56:20 AM Central Daylight Time		06/13/2022 08:29:28 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	108	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:24:47 PM Central Daylight Time		06/13/2022 08:29:55 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	113	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:24:34 PM Central Daylight Time		06/13/2022 08:30:21 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	118	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:24:21 PM Central Daylight Time		06/13/2022 08:30:47 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	123	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:24:06 PM Central Daylight Time		06/13/2022 08:31:14 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	128	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:23:05 PM Central Daylight Time		06/13/2022 08:31:40 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	133	0	2023	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	3	1						05/25/2022	2023.01	05/25/2022 04:45:02 PM Central Daylight Time		06/13/2022 08:32:07 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	138	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:22:25 PM Central Daylight Time		06/13/2022 08:32:34 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	143	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:22:05 PM Central Daylight Time		06/13/2022 08:33:00 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	148	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:21:50 PM Central Daylight Time		06/13/2022 08:33:26 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	153	0	2023	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	3	1						05/25/2022	2023.01	05/25/2022 04:47:13 PM Central Daylight Time		06/13/2022 08:33:52 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	158	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:21:12 PM Central Daylight Time		06/13/2022 08:34:18 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	163	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:20:15 PM Central Daylight Time		06/13/2022 08:34:44 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	214	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:20:00 PM Central Daylight Time		06/13/2022 08:35:09 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	215	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:19:45 PM Central Daylight Time		06/13/2022 08:35:35 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	216	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:19:30 PM Central Daylight Time		06/13/2022 08:36:01 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	217	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:19:14 PM Central Daylight Time		06/13/2022 08:36:27 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	218	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:18:57 PM Central Daylight Time		06/13/2022 08:36:53 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	219	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:18:41 PM Central Daylight Time		06/13/2022 08:37:20 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	220	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:18:26 PM Central Daylight Time		06/13/2022 08:37:46 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	221	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:18:10 PM Central Daylight Time		06/13/2022 08:38:11 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	222	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:17:54 PM Central Daylight Time		06/13/2022 08:38:37 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	223	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:17:36 PM Central Daylight Time		06/13/2022 08:39:03 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	224	0	2023	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	3	1						05/24/2022	2023.01	05/24/2022 11:34:29 AM Central Daylight Time		06/13/2022 08:39:28 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	225	0	2023	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	3	1						05/24/2022	2023.01	05/24/2022 11:35:55 AM Central Daylight Time		06/13/2022 08:39:54 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	226	0	2023	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	3	1						05/17/2022	2023.01	05/17/2022 10:16:39 PM Central Daylight Time		06/13/2022 08:40:19 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	227	0	2023	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	4	1					1	05/25/2022	2023.01	05/25/2022 02:45:13 PM Central Daylight Time		06/10/2022 02:10:58 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	246	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:45:03 PM Central Daylight Time		06/10/2022 02:11:23 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	247	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:44:57 PM Central Daylight Time		06/10/2022 02:11:49 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	248	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:44:48 PM Central Daylight Time		06/10/2022 02:12:14 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	249	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:44:40 PM Central Daylight Time		06/10/2022 02:12:40 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	250	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:44:33 PM Central Daylight Time		06/10/2022 02:13:05 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	251	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:44:25 PM Central Daylight Time		06/10/2022 02:13:29 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	252	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:44:17 PM Central Daylight Time		06/10/2022 02:13:55 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	253	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:44:06 PM Central Daylight Time		06/10/2022 02:14:20 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	254	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:43:59 PM Central Daylight Time		06/10/2022 02:14:45 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	255	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:43:53 PM Central Daylight Time		06/10/2022 02:15:10 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	256	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:43:46 PM Central Daylight Time		06/10/2022 02:15:35 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	257	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:43:39 PM Central Daylight Time		06/10/2022 02:16:01 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	258	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:43:30 PM Central Daylight Time		06/10/2022 02:16:27 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	259	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:43:22 PM Central Daylight Time		06/10/2022 02:16:51 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	260	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:43:16 PM Central Daylight Time		06/10/2022 02:17:16 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	261	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:43:09 PM Central Daylight Time		06/10/2022 02:17:41 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	262	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:43:03 PM Central Daylight Time		06/10/2022 02:18:06 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	263	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:42:57 PM Central Daylight Time		06/10/2022 02:18:30 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	264	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:42:51 PM Central Daylight Time		06/10/2022 02:18:55 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	265	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:42:44 PM Central Daylight Time		06/10/2022 02:19:20 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	266	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:42:38 PM Central Daylight Time		06/10/2022 02:19:44 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	267	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:42:32 PM Central Daylight Time		06/10/2022 02:20:10 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	268	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:42:25 PM Central Daylight Time		06/10/2022 02:20:34 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	269	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:42:20 PM Central Daylight Time		06/10/2022 02:21:00 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	270	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:42:13 PM Central Daylight Time		06/10/2022 02:21:24 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	271	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:42:05 PM Central Daylight Time		06/10/2022 02:21:49 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	272	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:41:58 PM Central Daylight Time		06/10/2022 02:22:14 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	273	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:41:52 PM Central Daylight Time		06/10/2022 02:22:38 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	274	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:41:46 PM Central Daylight Time		06/10/2022 02:23:03 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	275	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:41:40 PM Central Daylight Time		06/10/2022 02:23:27 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	276	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:41:34 PM Central Daylight Time		06/10/2022 02:23:52 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	277	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:41:27 PM Central Daylight Time		06/10/2022 02:24:17 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	278	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:41:21 PM Central Daylight Time		06/10/2022 02:24:42 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	279	0	2023	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	3	1						05/18/2022	2023.01	05/18/2022 01:46:49 PM Central Daylight Time		06/13/2022 08:40:44 AM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	348	0	2023	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	3	1					1	05/25/2022	2023.01	05/25/2022 02:41:13 PM Central Daylight Time		06/10/2022 02:25:06 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	349	0	2023	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	351	0		29	10	S5617_351_0	4	1						05/18/2022	2023.01	05/18/2022 01:44:08 PM Central Daylight Time		06/10/2022 02:47:31 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	351	0	2023	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	352	0		29	10	S5617_352_0	3	1						05/18/2022	2023.01	05/18/2022 01:43:52 PM Central Daylight Time		06/10/2022 02:47:56 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	352	0	2023	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	353	0		29	10	S5617_353_0	3	1						05/18/2022	2023.01	05/18/2022 01:43:59 PM Central Daylight Time		06/10/2022 02:48:21 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	353	0	2023	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	354	0		29	10	S5617_354_0	3	1						05/18/2022	2023.01	05/18/2022 02:04:25 PM Central Daylight Time		06/10/2022 02:48:46 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	354	0	2023	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	355	0		29	10	S5617_355_0	3	1						05/18/2022	2023.01	05/18/2022 10:44:16 AM Central Daylight Time		06/10/2022 02:49:11 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	355	0	2023	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	356	0		29	10	S5617_356_0	3	1						05/18/2022	2023.01	05/18/2022 10:44:30 AM Central Daylight Time		06/10/2022 02:49:36 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	356	0	2023	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	357	0		29	10	S5617_357_0	3	1						05/18/2022	2023.01	05/18/2022 10:44:42 AM Central Daylight Time		06/10/2022 02:50:01 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	357	0	2023	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	358	0		29	10	S5617_358_0	3	1						05/18/2022	2023.01	05/18/2022 10:44:53 AM Central Daylight Time		06/10/2022 02:50:27 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	358	0	2023	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	359	0		29	10	S5617_359_0	3	1						05/18/2022	2023.01	05/18/2022 10:45:03 AM Central Daylight Time		06/10/2022 02:50:52 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	359	0	2023	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	360	0		29	10	S5617_360_0	3	1						05/18/2022	2023.01	05/18/2022 10:45:24 AM Central Daylight Time		06/10/2022 02:51:19 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	360	0	2023	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	361	0		29	10	S5617_361_0	3	1						05/18/2022	2023.01	05/18/2022 10:45:34 AM Central Daylight Time		06/10/2022 02:51:44 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	361	0	2023	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	362	0		29	10	S5617_362_0	3	1						05/18/2022	2023.01	05/18/2022 10:45:45 AM Central Daylight Time		06/10/2022 02:52:09 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	362	0	2023	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	363	0		29	10	S5617_363_0	3	1						05/18/2022	2023.01	05/18/2022 10:46:00 AM Central Daylight Time		06/10/2022 02:52:34 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	363	0	2023	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	364	0		29	10	S5617_364_0	3	1						05/18/2022	2023.01	05/18/2022 10:46:10 AM Central Daylight Time		06/10/2022 02:53:00 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	364	0	2023	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	365	0		29	10	S5617_365_0	3	1						05/18/2022	2023.01	05/18/2022 10:46:21 AM Central Daylight Time		06/10/2022 02:53:24 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	365	0	2023	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	366	0		29	10	S5617_366_0	3	1						05/18/2022	2023.01	05/18/2022 10:46:30 AM Central Daylight Time		06/10/2022 02:53:49 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	366	0	2023	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	367	0		29	10	S5617_367_0	3	1						05/18/2022	2023.01	05/18/2022 10:46:40 AM Central Daylight Time		06/10/2022 02:54:14 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	367	0	2023	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	368	0		29	10	S5617_368_0	3	1						05/18/2022	2023.01	05/18/2022 10:46:58 AM Central Daylight Time		06/10/2022 02:54:39 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	368	0	2023	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	369	0		29	10	S5617_369_0	3	1						05/18/2022	2023.01	05/18/2022 10:47:07 AM Central Daylight Time		06/10/2022 02:55:04 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	369	0	2023	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	370	0		29	10	S5617_370_0	3	1						05/18/2022	2023.01	05/18/2022 10:47:16 AM Central Daylight Time		06/10/2022 02:55:29 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	370	0	2023	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	371	0		29	10	S5617_371_0	3	1						05/18/2022	2023.01	05/18/2022 10:47:25 AM Central Daylight Time		06/10/2022 02:55:55 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	371	0	2023	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	372	0		29	10	S5617_372_0	3	1						05/18/2022	2023.01	05/18/2022 02:04:18 PM Central Daylight Time		06/10/2022 02:56:20 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	372	0	2023	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	373	0		29	10	S5617_373_0	3	1						05/18/2022	2023.01	05/18/2022 10:47:43 AM Central Daylight Time		06/10/2022 02:56:45 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	373	0	2023	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	374	0		29	10	S5617_374_0	3	1						05/18/2022	2023.01	05/18/2022 10:47:52 AM Central Daylight Time		06/10/2022 02:57:10 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	374	0	2023	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	375	0		29	10	S5617_375_0	3	1						05/18/2022	2023.01	05/18/2022 10:48:02 AM Central Daylight Time		06/10/2022 02:57:35 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	375	0	2023	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	376	0		29	10	S5617_376_0	3	1						05/18/2022	2023.01	05/18/2022 10:48:48 AM Central Daylight Time		06/10/2022 02:58:02 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	376	0	2023	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	377	0		29	10	S5617_377_0	3	1						05/18/2022	2023.01	05/18/2022 10:48:58 AM Central Daylight Time		06/10/2022 02:58:29 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	377	0	2023	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	378	0		29	10	S5617_378_0	3	1						05/18/2022	2023.01	05/18/2022 10:49:08 AM Central Daylight Time		06/10/2022 02:58:55 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	378	0	2023	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	379	0		29	10	S5617_379_0	3	1						05/18/2022	2023.01	05/18/2022 10:49:19 AM Central Daylight Time		06/10/2022 02:59:21 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	379	0	2023	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	380	0		29	10	S5617_380_0	3	1						05/18/2022	2023.01	05/18/2022 10:49:36 AM Central Daylight Time		06/10/2022 02:59:47 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	380	0	2023	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	381	0		29	10	S5617_381_0	3	1						05/18/2022	2023.01	05/18/2022 10:49:47 AM Central Daylight Time		06/10/2022 03:00:13 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	381	0	2023	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	382	0		29	10	S5617_382_0	3	1						05/18/2022	2023.01	05/18/2022 10:50:02 AM Central Daylight Time		06/10/2022 03:00:38 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	382	0	2023	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	383	0		29	10	S5617_383_0	3	1						05/18/2022	2023.01	05/18/2022 10:50:11 AM Central Daylight Time		06/10/2022 03:01:04 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	383	0	2023	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	384	0		29	10	S5617_384_0	3	1						05/18/2022	2023.01	05/18/2022 10:50:21 AM Central Daylight Time		06/10/2022 03:01:29 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	384	0	2023	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	385	0		29	10	S5617_385_0	3	1						05/18/2022	2023.01	05/18/2022 10:50:30 AM Central Daylight Time		06/10/2022 03:01:54 PM Central Daylight Time			06/21/2022 03:25:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Saver Rx (PDP)	10	29					S5617	385	0	2023	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	2	1						05/17/2022	2023.01	05/17/2022 10:27:10 PM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Rx Medicare (PDP)	10	29					S5617	801	0	2023	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	2	1						05/17/2022	2023.01	05/17/2022 10:27:07 PM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Rx Medicare FY (PDP)	10	29					S5617	802	0	2023	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	2	1						05/17/2022	2023.01	05/17/2022 10:27:02 PM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Rx Medicare (PDP)	10	29					S5617	805	0	2023	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	2	1						05/17/2022	2023.01	05/17/2022 10:26:57 PM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Rx Medicare FY (PDP)	10	29					S5617	806	0	2023	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	2	1						05/17/2022	2023.01	05/17/2022 10:27:20 PM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	https://www.express-scripts.com	Express Scripts Medicare (PDP)	10	29					S5660	801	0	2023	Nationwide		1					2									https://www.express-scripts.com	https://www.express-scripts.com										(866)544-6963		(866)544-6963		(866)544-6963		(866)544-6963										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	802	0		29	10	S5660_802_0	2	1						05/17/2022	2023.01	05/17/2022 10:27:24 PM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	https://www.express-scripts.com	Express Scripts Medicare (PDP)	10	29					S5660	802	0	2023	Nationwide		1					2									https://www.express-scripts.com	https://www.express-scripts.com										(888)416-3326		(888)416-3326		(888)416-3326		(888)416-3326										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	803	0		29	10	S5660_803_0	2	1						05/17/2022	2023.01	05/17/2022 10:27:27 PM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	https://www.express-scripts.com	Express Scripts Medicare (PDP)	10	29					S5660	803	0	2023	Nationwide		1					2									https://www.express-scripts.com	https://www.express-scripts.com										(877)866-5834		(877)866-5834		(877)866-5834		(877)866-5834										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	804	0		29	10	S5660_804_0	2	1						05/17/2022	2023.01	05/17/2022 10:27:31 PM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	https://www.express-scripts.com	Express Scripts Medicare (PDP)	10	29					S5660	804	0	2023	Nationwide		1					2									https://www.express-scripts.com	https://www.express-scripts.com										(866)544-6963		(866)544-6963		(866)544-6963		(866)544-6963										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	806	0		29	10	S5660_806_0	2	1						05/17/2022	2023.01	05/17/2022 10:27:35 PM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	https://www.express-scripts.com	Express Scripts Medicare (PDP)	10	29					S5660	806	0	2023	Nationwide		1					2									https://www.express-scripts.com	https://www.express-scripts.com										(866)662-0274		(866)662-0274		(866)662-0274		(866)662-0274										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	813	0		29	10	S5660_813_0	2	1						05/24/2022	2023.01	05/24/2022 11:33:49 AM Central Daylight Time					06/01/2022 03:54:18 PM Central Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	https://www.express-scripts.com	Express Scripts Medicare (PDP)	10	29					S5660	813	0	2023	Nationwide		1					2									https://www.express-scripts.com	https://www.express-scripts.com										(866)544-6963		(866)544-6963		(866)544-6963		(866)544-6963										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5715	001	0		29	10	S5715_001_0	4	1						06/05/2022	2023.01	06/05/2022 09:38:52 PM Central Daylight Time		06/04/2022 10:06:59 PM Central Daylight Time			06/06/2022 07:47:39 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getblueil.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	001	0	2023	State of Illinois		2					2									getblueil.com/pdp/pharmacies	getblueil.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	003	0		29	10	S5715_003_0	4	1						06/05/2022	2023.01	06/05/2022 09:36:39 PM Central Daylight Time		06/04/2022 10:07:23 PM Central Daylight Time			06/06/2022 07:47:39 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getbluenm.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	003	0	2023	State of New Mexico		2					2									getbluenm.com/pdp/pharmacies	getbluenm.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	005	0		29	10	S5715_005_0	4	1						06/05/2022	2023.01	06/05/2022 09:37:24 PM Central Daylight Time		06/04/2022 10:07:47 PM Central Daylight Time			06/06/2022 07:47:39 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getbluetx.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	005	0	2023	State of Texas		2					2									getbluetx.com/pdp/pharmacies	getbluetx.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	010	0		29	10	S5715_010_0	4	1						06/05/2022	2023.01	06/05/2022 09:38:09 PM Central Daylight Time		06/04/2022 10:08:11 PM Central Daylight Time			06/06/2022 07:47:39 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getblueok.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	010	0	2023	State of Oklahoma		2					2									getblueok.com/pdp/pharmacies	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	5	1						06/05/2022	2023.01	06/05/2022 09:39:32 PM Central Daylight Time		06/04/2022 10:08:59 PM Central Daylight Time			06/06/2022 07:36:12 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getblueil.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	012	0	2023	State of Illinois		2					2									getblueil.com/pdp/pharmacies	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	5	1						06/05/2022	2023.01	06/05/2022 09:40:31 PM Central Daylight Time		06/04/2022 10:10:00 PM Central Daylight Time			06/06/2022 07:36:12 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getbluenm.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	013	0	2023	State of New Mexico		2					2									getbluenm.com/pdp/pharmacies	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	5	1						06/05/2022	2023.01	06/05/2022 09:41:41 PM Central Daylight Time		06/04/2022 10:11:00 PM Central Daylight Time			06/06/2022 07:36:12 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getbluetx.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	014	0	2023	State of Texas		2					2									getbluetx.com/pdp/pharmacies	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	5	1						06/05/2022	2023.01	06/05/2022 09:42:20 PM Central Daylight Time		06/04/2022 10:11:58 PM Central Daylight Time			06/06/2022 07:36:12 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getblueok.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	015	0	2023	State of Oklahoma		2					2									getblueok.com/pdp/pharmacies	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	5	1						07/12/2022	2023.01	07/12/2022 03:07:06 PM Central Daylight Time		07/12/2022 12:11:34 PM Central Daylight Time			07/13/2022 10:10:50 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getblueok.com/pdp	Blue Cross MedicareRx Choice (PDP)	10	29					S5715	018	0	2023	State of Oklahoma		2					2									getblueok.com/pdp/pharmacies	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						06/05/2022	2023.01	06/05/2022 09:45:39 PM Central Daylight Time		06/04/2022 10:13:55 PM Central Daylight Time			06/06/2022 09:04:48 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getblueil.com/pdp	Blue Cross MedicareRx Choice (PDP)	10	29					S5715	019	0	2023	Illinois		2					2									getblueil.com/pdp/pharmacies	getblueil.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	020	0		29	10	S5715_020_0	4	1						06/05/2022	2023.01	06/05/2022 09:47:33 PM Central Daylight Time		06/04/2022 10:14:52 PM Central Daylight Time			06/06/2022 09:04:48 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getbluenm.com/pdp	Blue Cross MedicareRx Choice (PDP)	10	29					S5715	020	0	2023	State of New Mexico		2					2									getbluenm.com/pdp/pharmacies	getbluenm.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	021	0		29	10	S5715_021_0	4	1						06/05/2022	2023.01	06/05/2022 09:48:17 PM Central Daylight Time		06/04/2022 10:15:50 PM Central Daylight Time			06/06/2022 09:04:48 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	getbluetx.com/pdp	Blue Cross MedicareRx Choice (PDP)	10	29					S5715	021	0	2023	State of Texas		2					2									getbluetx.com/pdp/pharmacies	getbluetx.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						06/02/2022	2023.01	06/02/2022 08:42:11 AM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						04/29/2022	2023.01	04/29/2022 09:45:45 AM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						04/29/2022	2023.01	04/29/2022 09:50:59 AM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						04/29/2022	2023.01	04/29/2022 09:50:53 AM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						05/12/2022	2023.01	05/12/2022 05:00:56 PM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						04/29/2022	2023.01	04/29/2022 09:45:26 AM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						05/12/2022	2023.01	05/12/2022 05:01:29 PM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						05/12/2022	2023.01	05/12/2022 05:01:39 PM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						05/12/2022	2023.01	05/12/2022 05:02:51 PM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						05/12/2022	2023.01	05/12/2022 05:02:46 PM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						04/29/2022	2023.01	04/29/2022 09:45:19 AM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						05/12/2022	2023.01	05/12/2022 05:02:26 PM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						05/12/2022	2023.01	05/12/2022 05:02:19 PM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						05/12/2022	2023.01	05/12/2022 05:02:13 PM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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						05/12/2022	2023.01	05/12/2022 05:02:07 PM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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	3	1						06/02/2022	2023.01	06/02/2022 08:41:53 AM Central Daylight Time					06/06/2022 08:35:13 AM 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	2023	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	2	1						05/26/2022	2023.01	05/26/2022 10:52:04 PM Eastern Daylight Time		05/29/2022 01:09:50 PM Eastern Daylight Time			06/02/2022 02:24:39 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	2023	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	3	1					1	05/26/2022	2023.01	05/26/2022 10:52:29 PM Eastern Daylight Time		05/29/2022 01:02:41 PM Eastern Daylight Time			06/02/2022 02:24:39 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	2023	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						04/21/2022	2023.01	04/21/2022 09:38:26 AM Eastern Daylight Time					06/02/2022 02:24:39 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	2023	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	3	1						06/03/2022	2023.01	06/03/2022 09:07:23 PM Central Daylight Time		06/05/2022 06:49:00 PM Central Daylight Time			06/05/2022 09:15:56 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	2023	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	3	1						06/03/2022	2023.01	06/03/2022 09:07:55 PM Central Daylight Time		06/05/2022 06:49:00 PM Central Daylight Time			06/05/2022 09:15:56 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	2023	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	008	0		29	10	S5743_008_0	3	1						06/03/2022	2023.01	06/03/2022 08:56:52 PM Central Daylight Time		06/01/2022 11:50:00 PM Central Daylight Time			06/03/2022 08:58:59 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	MedicareBlue Rx Select (PDP)	10	29					S5743	008	0	2023	States of IA, MN, MT, NE, ND, SD, WY		2					2									www.YourMedicareSolutions.com	www.YourMedicareSolutions.com										(888)832-0075		(888)832-0075		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-																
S5743	802	0		29	10	S5743_802_0	1	1						06/03/2022	2023.01	06/03/2022 05:07:52 PM Central Daylight Time					06/03/2022 05:10:13 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	2023	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	1	1						06/03/2022	2023.01	06/03/2022 05:09:18 PM Central Daylight Time					06/03/2022 05:10:13 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	2023	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)-																
S5795	002	0		29	10	S5795_002_0	1	1						05/23/2022	2023.01	05/23/2022 12:05:51 PM Central Daylight Time		06/03/2022 04:59:43 PM Central Daylight Time			06/03/2022 05:09:19 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Premier Rx (PDP)	10	29					S5795	002	0	2023	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	3	1						07/05/2022	2023.01	07/05/2022 03:25:07 PM Central Daylight Time		07/13/2022 12:02:52 PM Central Daylight Time			07/15/2022 02:22:58 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Value Rx (PDP)	10	29					S5795	003	0	2023	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	804	0		29	10	S5795_804_0	1	1						05/06/2022	2023.01	05/06/2022 11:33:26 AM Central Daylight Time					06/03/2022 05:09:19 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	2023	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						05/06/2022	2023.01	05/06/2022 11:33:38 AM Central Daylight Time					06/03/2022 05:09:19 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	2023	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						05/06/2022	2023.01	05/06/2022 11:33:46 AM Central Daylight Time					06/03/2022 05:09:19 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com	ABCBS Group Basic CY (PDP)	10	29					S5795	811	0	2023	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						05/06/2022	2023.01	05/06/2022 11:33:52 AM Central Daylight Time					06/03/2022 05:09:19 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com	ABCBS Group Basic PY (PDP)	10	29					S5795	812	0	2023	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	06/08/2022	2023.01	06/08/2022 08:56:54 AM Central Daylight Time		06/03/2022 02:42:03 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5805	001	0	2023	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						06/03/2022	2023.01	06/03/2022 10:49:34 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	803	0	2023	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						06/03/2022	2023.01	06/03/2022 10:49:43 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	804	0	2023	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						06/03/2022	2023.01	06/03/2022 10:49:48 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	807	0	2023	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						06/03/2022	2023.01	06/03/2022 10:49:52 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	808	0	2023	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						06/03/2022	2023.01	06/03/2022 10:49:58 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	809	0	2023	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						06/03/2022	2023.01	06/03/2022 10:50:03 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	810	0	2023	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						06/03/2022	2023.01	06/03/2022 10:50:10 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	811	0	2023	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						06/03/2022	2023.01	06/03/2022 10:50:33 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	812	0	2023	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						06/03/2022	2023.01	06/03/2022 10:50:40 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	813	0	2023	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						06/03/2022	2023.01	06/03/2022 10:50:46 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	814	0	2023	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						06/03/2022	2023.01	06/03/2022 10:53:30 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	815	0	2023	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						06/03/2022	2023.01	06/03/2022 10:53:36 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	816	0	2023	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						06/03/2022	2023.01	06/03/2022 10:53:42 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	818	0	2023	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						06/03/2022	2023.01	06/03/2022 10:53:47 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	819	0	2023	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						06/03/2022	2023.01	06/03/2022 10:53:54 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	820	0	2023	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						06/03/2022	2023.01	06/03/2022 11:05:19 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	821	0	2023	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						06/03/2022	2023.01	06/03/2022 11:05:25 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	822	0	2023	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						06/03/2022	2023.01	06/03/2022 11:05:31 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	823	0	2023	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						06/03/2022	2023.01	06/03/2022 11:05:42 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	824	0	2023	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						06/03/2022	2023.01	06/03/2022 11:06:28 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	825	0	2023	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						06/03/2022	2023.01	06/03/2022 11:06:33 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	826	0	2023	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						06/03/2022	2023.01	06/03/2022 11:06:39 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	827	0	2023	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						06/03/2022	2023.01	06/03/2022 11:06:45 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	828	0	2023	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						06/03/2022	2023.01	06/03/2022 11:06:50 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	829	0	2023	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						06/03/2022	2023.01	06/03/2022 11:06:56 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	830	0	2023	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						06/03/2022	2023.01	06/03/2022 11:07:03 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	831	0	2023	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						06/03/2022	2023.01	06/03/2022 11:07:08 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	832	0	2023	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						06/03/2022	2023.01	06/03/2022 11:07:14 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	833	0	2023	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						06/03/2022	2023.01	06/03/2022 11:07:20 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	834	0	2023	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						06/03/2022	2023.01	06/03/2022 11:07:36 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	835	0	2023	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						06/03/2022	2023.01	06/03/2022 11:07:41 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	836	0	2023	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						06/03/2022	2023.01	06/03/2022 11:07:47 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	837	0	2023	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						06/03/2022	2023.01	06/03/2022 11:07:52 AM Eastern Daylight Time					06/03/2022 03:25:15 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	838	0	2023	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	3	1					1	06/08/2022	2023.01	06/08/2022 08:54:50 AM Central Daylight Time		06/03/2022 02:42:27 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	001	0	2023	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	3	1					1	06/08/2022	2023.01	06/08/2022 08:56:36 AM Central Daylight Time		06/03/2022 02:42:50 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	002	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:42:35 PM Central Daylight Time		06/03/2022 02:43:13 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	003	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:42:52 PM Central Daylight Time		06/03/2022 02:43:37 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	004	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:43:20 PM Central Daylight Time		06/03/2022 02:44:01 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	005	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:44:19 PM Central Daylight Time		06/03/2022 02:44:25 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	006	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:44:37 PM Central Daylight Time		06/03/2022 02:44:49 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	007	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:44:58 PM Central Daylight Time		06/03/2022 02:45:12 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	008	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:45:18 PM Central Daylight Time		06/03/2022 02:45:36 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	009	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:45:50 PM Central Daylight Time		06/03/2022 02:46:00 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	010	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:50:38 PM Central Daylight Time		06/03/2022 02:46:23 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	011	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:51:00 PM Central Daylight Time		06/03/2022 02:46:47 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	012	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:51:24 PM Central Daylight Time		06/03/2022 02:47:10 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	013	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:51:45 PM Central Daylight Time		06/03/2022 02:47:33 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	014	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:55:20 PM Central Daylight Time		06/03/2022 02:47:57 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	015	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:55:50 PM Central Daylight Time		06/03/2022 02:48:20 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	016	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:56:23 PM Central Daylight Time		06/03/2022 02:48:43 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	017	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:56:45 PM Central Daylight Time		06/03/2022 02:49:07 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	018	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:57:08 PM Central Daylight Time		06/03/2022 02:49:31 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	019	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:57:29 PM Central Daylight Time		06/03/2022 02:49:54 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	020	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:57:57 PM Central Daylight Time		06/03/2022 02:50:17 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	021	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:58:21 PM Central Daylight Time		06/03/2022 02:50:40 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	022	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:58:45 PM Central Daylight Time		06/03/2022 02:51:04 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	023	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:59:09 PM Central Daylight Time		06/03/2022 02:51:27 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	024	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 01:59:33 PM Central Daylight Time		06/03/2022 02:51:50 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	025	0	2023	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	4	1					1	06/07/2022	2023.01	06/07/2022 02:00:00 PM Central Daylight Time		06/03/2022 02:52:14 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	026	0	2023	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	4	1					1	06/07/2022	2023.01	06/07/2022 02:00:27 PM Central Daylight Time		06/03/2022 02:52:37 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	027	0	2023	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	4	1					1	06/07/2022	2023.01	06/07/2022 02:00:58 PM Central Daylight Time		06/03/2022 02:53:00 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	028	0	2023	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	4	1					1	06/07/2022	2023.01	06/07/2022 02:01:20 PM Central Daylight Time		06/03/2022 02:53:23 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	029	0	2023	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	4	1					1	06/07/2022	2023.01	06/07/2022 02:01:44 PM Central Daylight Time		06/03/2022 02:53:47 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	030	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 02:02:12 PM Central Daylight Time		06/03/2022 02:54:10 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	031	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 02:02:53 PM Central Daylight Time		06/03/2022 02:54:34 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	032	0	2023	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	3	1					1	06/07/2022	2023.01	06/07/2022 02:03:21 PM Central Daylight Time		06/03/2022 02:54:57 PM Central Daylight Time			06/08/2022 01:20:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	033	0	2023	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	05/29/2022	2023.01	05/29/2022 08:55:36 AM Central Daylight Time		06/03/2022 02:55:20 PM Central Daylight Time			06/04/2022 09:02:08 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	034	0	2023	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	05/29/2022	2023.01	05/29/2022 08:54:41 AM Central Daylight Time		06/03/2022 02:55:44 PM Central Daylight Time			06/04/2022 09:02:08 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	035	0	2023	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	2	1					0	05/29/2022	2023.01	05/29/2022 08:54:29 AM Central Daylight Time		06/03/2022 02:56:07 PM Central Daylight Time			06/04/2022 09:02:08 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	036	0	2023	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	05/29/2022	2023.01	05/29/2022 08:54:15 AM Central Daylight Time		06/03/2022 02:56:31 PM Central Daylight Time			06/04/2022 09:02:08 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	037	0	2023	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	05/29/2022	2023.01	05/29/2022 08:54:04 AM Central Daylight Time		06/03/2022 02:56:54 PM Central Daylight Time			06/04/2022 09:02:08 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	038	0	2023	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						06/03/2022	2023.01	06/03/2022 11:08:12 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	803	0	2023	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						06/03/2022	2023.01	06/03/2022 11:08:17 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	804	0	2023	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						06/03/2022	2023.01	06/03/2022 11:08:22 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	807	0	2023	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						06/03/2022	2023.01	06/03/2022 11:08:27 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	808	0	2023	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						06/03/2022	2023.01	06/03/2022 11:08:34 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	810	0	2023	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						06/03/2022	2023.01	06/03/2022 11:08:40 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	811	0	2023	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						06/03/2022	2023.01	06/03/2022 11:08:45 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	812	0	2023	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						06/03/2022	2023.01	06/03/2022 11:08:50 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	813	0	2023	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						06/03/2022	2023.01	06/03/2022 11:08:55 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	814	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:00 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	815	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:05 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	816	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:11 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	817	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:18 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	818	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:23 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	819	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:29 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	820	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:34 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	821	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:39 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	822	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:44 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	823	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:50 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	824	0	2023	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						06/03/2022	2023.01	06/03/2022 11:09:55 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	825	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:01 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	826	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:07 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	827	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:12 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	828	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:18 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	829	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:23 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	830	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:28 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	831	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:33 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	832	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:39 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	833	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:44 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	834	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:49 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	835	0	2023	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						06/03/2022	2023.01	06/03/2022 11:10:54 AM Eastern Daylight Time					06/03/2022 03:28:32 PM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	836	0	2023	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	1	1						04/27/2022	2023.01	04/27/2022 09:04:47 AM Eastern Daylight Time					06/06/2022 10:09:23 AM Eastern Daylight Time	PRIORITY HEALTH INSURANCE COMPANY	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Rx EG Non-Calendar Year (PDP)	10	29					S5857	802	0	2023	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	1	1						04/27/2022	2023.01	04/27/2022 09:04:54 AM Eastern Daylight Time					06/06/2022 10:09:23 AM Eastern Daylight Time	PRIORITY HEALTH INSURANCE COMPANY	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Rx EG Calendar Year (PDP)	10	29					S5857	803	0	2023	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						05/19/2022	2023.01	05/19/2022 03:09:23 PM Mountain Daylight Time					05/19/2022 03:10:00 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	www.emihealth.com	Alpine School District Retiree Plan (PDP)	10	29					S5877	803	0	2023	State of Utah and State of Idaho		1					2									http://www.express-scripts.com	https://medicare.emihealth.com/Formulary.aspx										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476																
S5877	804	0		29	10	S5877_804_0	1	1						05/19/2022	2023.01	05/19/2022 03:09:28 PM Mountain Daylight Time					05/19/2022 03:10:00 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	www.emihealth.com	Educators Mutual Retiree Plan (PDP)	10	29					S5877	804	0	2023	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	2	1						05/28/2022	2023.01	05/28/2022 08:49:51 AM Eastern Daylight Time		05/31/2022 11:54:44 AM Eastern Daylight Time			06/02/2022 10:16:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	101	0	2023	States of Maine and New Hampshire		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 08:51:08 AM Eastern Daylight Time		05/31/2022 11:55:10 AM Eastern Daylight Time			06/02/2022 10:16:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	102	0	2023	States of CT, MA, RI, VT		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 08:52:25 AM Eastern Daylight Time		05/31/2022 11:55:34 AM Eastern Daylight Time			06/02/2022 10:16:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	103	0	2023	States of DC, DE, MD		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 08:53:42 AM Eastern Daylight Time		05/31/2022 11:56:00 AM Eastern Daylight Time			06/02/2022 10:16:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	104	0	2023	States of Pennsylvania and West Virginia		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 08:54:59 AM Eastern Daylight Time		05/31/2022 11:56:24 AM Eastern Daylight Time			06/02/2022 10:16:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	105	0	2023	State of Florida		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 08:56:15 AM Eastern Daylight Time		05/31/2022 11:56:54 AM Eastern Daylight Time			06/02/2022 10:16:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	106	0	2023	States of Alabama and Tennessee		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 08:57:32 AM Eastern Daylight Time		05/31/2022 11:57:20 AM Eastern Daylight Time			06/02/2022 10:16:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	107	0	2023	State of Illinois		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 08:58:49 AM Eastern Daylight Time		05/31/2022 11:57:44 AM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	108	0	2023	State of Louisiana		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:00:06 AM Eastern Daylight Time		05/31/2022 11:58:10 AM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	109	0	2023	State of Kansas		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:01:23 AM Eastern Daylight Time		05/31/2022 11:58:34 AM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	110	0	2023	State of New Mexico		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:02:44 AM Eastern Daylight Time		05/31/2022 11:59:00 AM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	111	0	2023	State of Colorado		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:04:01 AM Eastern Daylight Time		05/31/2022 11:59:24 AM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	112	0	2023	State of Nevada		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:05:18 AM Eastern Daylight Time		05/31/2022 11:59:50 AM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	113	0	2023	States of Oregon and Washington		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:06:40 AM Eastern Daylight Time		05/31/2022 12:00:14 PM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	114	0	2023	State of California		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:07:58 AM Eastern Daylight Time		05/31/2022 12:00:38 PM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	115	0	2023	State of Hawaii		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:09:16 AM Eastern Daylight Time		05/31/2022 12:01:04 PM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	116	0	2023	State of Alaska		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:10:39 AM Eastern Daylight Time		05/31/2022 12:01:28 PM Eastern Daylight Time			06/02/2022 10:36:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	131	0	2023	State of New Jersey		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1						05/28/2022	2023.01	05/28/2022 09:11:56 AM Eastern Daylight Time		07/26/2022 01:08:58 PM Eastern Daylight Time			07/27/2022 03:05:46 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	132	0	2023	State of Virginia		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:13:14 AM Eastern Daylight Time		05/31/2022 12:02:18 PM Eastern Daylight Time			06/02/2022 10:42:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	133	0	2023	State of North Carolina		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:14:38 AM Eastern Daylight Time		05/31/2022 12:02:42 PM Eastern Daylight Time			06/02/2022 10:42:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	134	0	2023	State of South Carolina		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:15:56 AM Eastern Daylight Time		05/31/2022 12:03:06 PM Eastern Daylight Time			06/02/2022 10:42:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	135	0	2023	State of Georgia		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:17:13 AM Eastern Daylight Time		05/31/2022 12:03:30 PM Eastern Daylight Time			06/02/2022 10:42:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	136	0	2023	State of Michigan		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:18:32 AM Eastern Daylight Time		05/31/2022 12:03:56 PM Eastern Daylight Time			06/02/2022 10:42:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	137	0	2023	State of Ohio		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:19:48 AM Eastern Daylight Time		05/31/2022 12:04:20 PM Eastern Daylight Time			06/02/2022 10:42:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	138	0	2023	States of Indiana and Kentucky		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:21:05 AM Eastern Daylight Time		05/31/2022 12:04:46 PM Eastern Daylight Time			06/02/2022 10:42:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	139	0	2023	State of Wisconsin		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:22:23 AM Eastern Daylight Time		05/31/2022 12:05:10 PM Eastern Daylight Time			06/02/2022 10:42:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	140	0	2023	State of Missouri		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:23:41 AM Eastern Daylight Time		05/31/2022 12:05:36 PM Eastern Daylight Time			06/02/2022 10:42:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	141	0	2023	State of Arkansas		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:24:59 AM Eastern Daylight Time		05/31/2022 12:06:00 PM Eastern Daylight Time			06/02/2022 10:48:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	142	0	2023	State of Mississippi		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:26:20 AM Eastern Daylight Time		05/31/2022 12:06:24 PM Eastern Daylight Time			06/02/2022 10:48:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	143	0	2023	State of Texas		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:27:37 AM Eastern Daylight Time		05/31/2022 12:06:50 PM Eastern Daylight Time			06/02/2022 10:48:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	144	0	2023	State of Oklahoma		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1						05/28/2022	2023.01	05/28/2022 09:28:54 AM Eastern Daylight Time		07/26/2022 01:10:12 PM Eastern Daylight Time			07/27/2022 03:05:46 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	145	0	2023	States of IA, MN, MT, ND, NE, SD, WY		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1						05/28/2022	2023.01	05/28/2022 09:30:17 AM Eastern Daylight Time		07/26/2022 01:11:26 PM Eastern Daylight Time			07/27/2022 03:05:46 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	146	0	2023	State of Arizona		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 09:31:35 AM Eastern Daylight Time		05/31/2022 12:08:04 PM Eastern Daylight Time			06/02/2022 10:48:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	147	0	2023	States of Idaho and Utah		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	3	1					1	05/28/2022	2023.01	05/28/2022 09:32:53 AM Eastern Daylight Time		07/14/2022 11:52:20 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	148	0	2023	States of Maine and New Hampshire		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:34:12 AM Eastern Daylight Time		07/14/2022 11:52:46 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	149	0	2023	States of CT, MA, RI, VT		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	150	0		29	10	S5884_150_0	2	1					1	05/28/2022	2023.01	05/28/2022 09:35:30 AM Eastern Daylight Time		07/14/2022 11:53:10 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	150	0	2023	State of New Jersey		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:36:49 AM Eastern Daylight Time		07/14/2022 11:53:34 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	151	0	2023	States of DC, DE, MD		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:38:07 AM Eastern Daylight Time		07/14/2022 11:54:00 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	152	0	2023	States of Pennsylvania and West Virginia		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	153	0		29	10	S5884_153_0	2	1					1	05/28/2022	2023.01	05/28/2022 09:39:26 AM Eastern Daylight Time		07/14/2022 11:54:24 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	153	0	2023	State of Virginia		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:40:45 AM Eastern Daylight Time		07/14/2022 11:54:48 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	154	0	2023	State of North Carolina		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:42:02 AM Eastern Daylight Time		07/14/2022 11:55:14 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	155	0	2023	State of South Carolina		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:43:21 AM Eastern Daylight Time		07/14/2022 11:55:38 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	156	0	2023	State of Georgia		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:44:40 AM Eastern Daylight Time		07/14/2022 11:56:02 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	157	0	2023	State of Florida		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	158	0		29	10	S5884_158_0	2	1					1	05/28/2022	2023.01	05/28/2022 09:45:57 AM Eastern Daylight Time		07/14/2022 11:56:28 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	158	0	2023	States of Alabama and Tennessee		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:47:15 AM Eastern Daylight Time		07/14/2022 11:56:52 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	159	0	2023	State of Michigan		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:48:33 AM Eastern Daylight Time		07/14/2022 11:57:16 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	160	0	2023	State of Ohio		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	161	0		29	10	S5884_161_0	2	1					1	05/28/2022	2023.01	05/28/2022 09:49:50 AM Eastern Daylight Time		07/14/2022 11:57:42 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	161	0	2023	States of Indiana and Kentucky		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	162	0		29	10	S5884_162_0	2	1					1	05/28/2022	2023.01	05/28/2022 09:51:08 AM Eastern Daylight Time		07/14/2022 11:58:06 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	162	0	2023	State of Wisconsin		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:52:26 AM Eastern Daylight Time		07/14/2022 11:58:30 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	163	0	2023	State of Illinois		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:53:44 AM Eastern Daylight Time		07/14/2022 11:58:54 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	164	0	2023	State of Missouri		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:55:03 AM Eastern Daylight Time		07/14/2022 11:59:20 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	165	0	2023	State of Arkansas		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 09:56:21 AM Eastern Daylight Time		07/14/2022 11:59:44 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	166	0	2023	State of Mississippi		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	167	0		29	10	S5884_167_0	2	1					1	05/28/2022	2023.01	05/28/2022 09:57:39 AM Eastern Daylight Time		07/15/2022 09:41:58 AM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	167	0	2023	State of Louisiana		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	168	0		29	10	S5884_168_0	2	1					1	05/28/2022	2023.01	05/28/2022 09:58:58 AM Eastern Daylight Time		07/14/2022 12:00:34 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	168	0	2023	State of Texas		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	169	0		29	10	S5884_169_0	2	1					1	05/28/2022	2023.01	05/28/2022 10:00:16 AM Eastern Daylight Time		07/14/2022 12:00:58 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	169	0	2023	State of Oklahoma		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	170	0		29	10	S5884_170_0	2	1					1	05/28/2022	2023.01	05/28/2022 10:01:33 AM Eastern Daylight Time		07/14/2022 12:01:24 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	170	0	2023	State of Kansas		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 10:02:55 AM Eastern Daylight Time		07/14/2022 12:01:48 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	171	0	2023	States of IA, MN, MT, ND, NE, SD, WY		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 10:04:13 AM Eastern Daylight Time		07/14/2022 12:02:12 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	172	0	2023	State of New Mexico		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	173	0		29	10	S5884_173_0	2	1					1	05/28/2022	2023.01	05/28/2022 10:05:31 AM Eastern Daylight Time		07/14/2022 12:02:36 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	173	0	2023	State of Colorado		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 10:06:55 AM Eastern Daylight Time		07/14/2022 12:03:00 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	174	0	2023	State of Arizona		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	175	0		29	10	S5884_175_0	2	1					1	05/28/2022	2023.01	05/28/2022 10:08:13 AM Eastern Daylight Time		07/14/2022 12:03:26 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	175	0	2023	State of Nevada		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 10:09:31 AM Eastern Daylight Time		07/14/2022 12:03:50 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	176	0	2023	States of Oregon and Washington		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	177	0		29	10	S5884_177_0	2	1					1	05/28/2022	2023.01	05/28/2022 10:10:50 AM Eastern Daylight Time		07/14/2022 12:04:14 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	177	0	2023	States of Idaho and Utah		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/medicare-drug-list										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	178	0		29	10	S5884_178_0	2	1					1	05/28/2022	2023.01	05/28/2022 10:12:07 AM Eastern Daylight Time		07/14/2022 12:04:40 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	178	0	2023	State of California		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 10:13:26 AM Eastern Daylight Time		07/14/2022 12:05:04 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	179	0	2023	State of Hawaii		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1					1	05/28/2022	2023.01	05/28/2022 10:14:45 AM Eastern Daylight Time		07/14/2022 12:05:28 PM Eastern Daylight Time			07/20/2022 02:53:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	180	0	2023	State of Alaska		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1						05/28/2022	2023.01	05/28/2022 10:16:03 AM Eastern Daylight Time		05/31/2022 12:22:04 PM Eastern Daylight Time			06/02/2022 10:48:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	181	0	2023	States of Maine and New Hampshire		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:17:21 AM Eastern Daylight Time		05/31/2022 12:22:30 PM Eastern Daylight Time			06/02/2022 10:48:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	182	0	2023	States of CT, MA, RI, VT		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:18:40 AM Eastern Daylight Time		05/31/2022 12:22:54 PM Eastern Daylight Time			06/02/2022 10:48:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	183	0	2023	State of New Jersey		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:19:57 AM Eastern Daylight Time		05/31/2022 12:23:18 PM Eastern Daylight Time			06/02/2022 10:48:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	184	0	2023	States of DC, DE, MD		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:21:14 AM Eastern Daylight Time		05/31/2022 12:23:44 PM Eastern Daylight Time			06/02/2022 10:54:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	185	0	2023	States of Pennsylvania and West Virginia		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1						07/12/2022	2023.01	07/12/2022 01:00:23 PM Eastern Daylight Time		07/11/2022 03:00:44 PM Eastern Daylight Time			07/13/2022 03:18:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	186	0	2023	State of Virginia		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:23:52 AM Eastern Daylight Time		05/31/2022 12:24:32 PM Eastern Daylight Time			06/02/2022 10:54:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	187	0	2023	State of North Carolina		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:25:10 AM Eastern Daylight Time		05/31/2022 12:24:58 PM Eastern Daylight Time			06/02/2022 10:54:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	188	0	2023	State of South Carolina		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:26:32 AM Eastern Daylight Time		05/31/2022 12:25:22 PM Eastern Daylight Time			06/02/2022 10:54:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	189	0	2023	State of Georgia		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:27:50 AM Eastern Daylight Time		05/31/2022 12:25:46 PM Eastern Daylight Time			06/02/2022 10:54:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	190	0	2023	State of Florida		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:29:10 AM Eastern Daylight Time		05/31/2022 12:26:10 PM Eastern Daylight Time			06/02/2022 10:54:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	191	0	2023	States of Alabama and Tennessee		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:30:29 AM Eastern Daylight Time		05/31/2022 12:26:36 PM Eastern Daylight Time			06/02/2022 10:54:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	192	0	2023	State of Michigan		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:31:52 AM Eastern Daylight Time		05/31/2022 12:27:00 PM Eastern Daylight Time			06/02/2022 10:54:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	193	0	2023	State of Ohio		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:33:14 AM Eastern Daylight Time		05/31/2022 12:27:26 PM Eastern Daylight Time			06/02/2022 10:54:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	194	0	2023	States of Indiana and Kentucky		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1						07/12/2022	2023.01	07/12/2022 01:01:04 PM Eastern Daylight Time		07/11/2022 02:41:10 PM Eastern Daylight Time			07/13/2022 03:18:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	195	0	2023	State of Wisconsin		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:36:01 AM Eastern Daylight Time		05/31/2022 12:28:14 PM Eastern Daylight Time			06/02/2022 11:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	196	0	2023	State of Illinois		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1						07/12/2022	2023.01	07/12/2022 01:16:22 PM Eastern Daylight Time		07/11/2022 02:42:30 PM Eastern Daylight Time			07/13/2022 03:18:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	197	0	2023	State of Missouri		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:38:47 AM Eastern Daylight Time		05/31/2022 12:29:04 PM Eastern Daylight Time			06/02/2022 11:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	198	0	2023	State of Arkansas		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:40:12 AM Eastern Daylight Time		05/31/2022 12:29:28 PM Eastern Daylight Time			06/02/2022 11:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	199	0	2023	State of Mississippi		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:41:38 AM Eastern Daylight Time		05/31/2022 12:29:52 PM Eastern Daylight Time			06/02/2022 11:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	200	0	2023	State of Louisiana		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:42:59 AM Eastern Daylight Time		05/31/2022 12:30:16 PM Eastern Daylight Time			06/02/2022 11:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	201	0	2023	State of Texas		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:44:21 AM Eastern Daylight Time		05/31/2022 12:30:42 PM Eastern Daylight Time			06/02/2022 11:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	202	0	2023	State of Oklahoma		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:45:47 AM Eastern Daylight Time		05/31/2022 12:31:06 PM Eastern Daylight Time			06/02/2022 11:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	203	0	2023	State of Kansas		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:47:09 AM Eastern Daylight Time		05/31/2022 12:31:30 PM Eastern Daylight Time			06/02/2022 11:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	204	0	2023	States of IA, MN, MT, ND, NE, SD, WY		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:48:34 AM Eastern Daylight Time		05/31/2022 12:31:54 PM Eastern Daylight Time			06/02/2022 11:06:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	205	0	2023	State of New Mexico		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:49:58 AM Eastern Daylight Time		05/31/2022 12:32:20 PM Eastern Daylight Time			06/02/2022 11:06:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	206	0	2023	State of Colorado		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:51:19 AM Eastern Daylight Time		05/31/2022 12:32:44 PM Eastern Daylight Time			06/02/2022 11:06:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	207	0	2023	State of Arizona		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:52:39 AM Eastern Daylight Time		05/31/2022 12:33:08 PM Eastern Daylight Time			06/02/2022 11:06:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	208	0	2023	State of Nevada		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1						07/12/2022	2023.01	07/12/2022 02:57:24 PM Eastern Daylight Time		07/11/2022 02:43:46 PM Eastern Daylight Time			07/13/2022 03:18:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	209	0	2023	States of Oregon and Washington		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	2	1						07/12/2022	2023.01	07/12/2022 01:17:23 PM Eastern Daylight Time		07/11/2022 02:45:04 PM Eastern Daylight Time			07/13/2022 03:18:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	210	0	2023	States of Idaho and Utah		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:56:39 AM Eastern Daylight Time		05/31/2022 12:34:22 PM Eastern Daylight Time			06/02/2022 11:06:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	211	0	2023	State of California		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:58:00 AM Eastern Daylight Time		05/31/2022 12:34:48 PM Eastern Daylight Time			06/02/2022 11:06:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	212	0	2023	State of Hawaii		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	1	1						05/28/2022	2023.01	05/28/2022 10:59:22 AM Eastern Daylight Time		05/31/2022 12:35:12 PM Eastern Daylight Time			06/02/2022 11:06:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	213	0	2023	State of Alaska		2					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	4	1						05/20/2022	2023.01	05/20/2022 12:14:37 PM Eastern Daylight Time					05/31/2022 11:22:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S5884	834	0	2023	All Regions		1					2									https://www.humana.com/pharmacy/	https://www.humana.com/pharmacy/prescription-coverages/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	7	1					0	06/05/2022	2023.01	06/05/2022 01:54:17 PM Eastern Daylight Time		07/26/2022 12:34:02 PM Eastern Daylight Time			07/26/2022 01:28:10 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	2023	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	5	1					1	06/05/2022	2023.01	06/05/2022 01:55:32 PM Eastern Daylight Time		06/06/2022 07:49:33 PM Eastern Daylight Time			06/06/2022 09:02:50 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	2023	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						06/05/2022	2023.01	06/05/2022 01:57:26 PM Eastern Daylight Time					06/06/2022 09:02:50 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	2023	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						06/05/2022	2023.01	06/05/2022 01:57:54 PM Eastern Daylight Time					06/06/2022 09:02:50 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	2023	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	5	1						05/20/2022	2023.01	05/20/2022 03:06:04 PM Pacific Daylight Time		06/01/2022 05:02:34 PM Pacific Daylight Time			06/03/2022 12:02:15 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	2023	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)-		(800)735-2900		(711)-																
S5916	002	0		29	10	S5916_002_0	5	1						05/20/2022	2023.01	05/20/2022 03:05:32 PM Pacific Daylight Time		06/01/2022 05:03:44 PM Pacific Daylight Time			06/03/2022 12:02:15 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 Enhanced (PDP)	10	29					S5916	002	0	2023	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)-		(800)735-2900		(711)-																
S5916	802	0		29	10	S5916_802_0	1	1						04/18/2022	2023.01	04/18/2022 10:07:55 AM Pacific Daylight Time					05/17/2022 02:26:52 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 (PDP)	10	29					S5916	802	0	2023	Nationwide except territories		1					2									www.regence.com/medicare	www.regence.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5916	804	0		29	10	S5916_804_0	1	1						04/18/2022	2023.01	04/18/2022 10:08:04 AM Pacific Daylight Time					05/17/2022 02:26:52 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 02 (PDP)	10	29					S5916	804	0	2023	Nationwide except Territories		1					2									www.regence.com/medicare	www.regence.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5916	805	0		29	10	S5916_805_0	1	1						04/18/2022	2023.01	04/18/2022 10:08:11 AM Pacific Daylight Time					05/17/2022 02:26:52 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 03 (PDP)	10	29					S5916	805	0	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:01:11 AM Central Daylight Time		06/03/2022 02:57:17 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:01:20 AM Central Daylight Time		06/03/2022 02:57:41 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:01:29 AM Central Daylight Time		06/03/2022 02:58:05 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:01:38 AM Central Daylight Time		06/03/2022 02:58:28 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	3	1						05/29/2022	2023.01	05/29/2022 09:01:49 AM Central Daylight Time		07/25/2022 08:57:26 AM Central Daylight Time			07/26/2022 11:30:45 AM 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:07:01 AM Central Daylight Time		06/03/2022 02:59:15 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:07:12 AM Central Daylight Time		06/03/2022 02:59:39 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:07:20 AM Central Daylight Time		06/03/2022 03:00:02 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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						05/29/2022	2023.01	05/29/2022 09:07:50 AM Central Daylight Time		07/25/2022 08:58:44 AM Central Daylight Time			07/26/2022 11:30:45 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:07:35 AM Central Daylight Time		06/03/2022 03:00:49 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:08:03 AM Central Daylight Time		06/03/2022 03:01:12 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:08:13 AM Central Daylight Time		06/03/2022 03:01:35 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:08:22 AM Central Daylight Time		06/03/2022 03:01:58 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:13:01 AM Central Daylight Time		06/03/2022 03:02:22 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:13:09 AM Central Daylight Time		06/03/2022 03:02:45 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:12:46 AM Central Daylight Time		06/03/2022 03:03:08 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:12:36 AM Central Daylight Time		06/03/2022 03:03:32 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:12:25 AM Central Daylight Time		06/03/2022 03:03:55 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	3	1						05/29/2022	2023.01	05/29/2022 09:12:17 AM Central Daylight Time		07/25/2022 09:00:06 AM Central Daylight Time			07/26/2022 11:30:45 AM 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	2023	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	4	1						05/29/2022	2023.01	05/29/2022 09:12:06 AM Central Daylight Time		06/03/2022 03:04:42 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:11:55 AM Central Daylight Time		06/03/2022 03:05:05 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:11:47 AM Central Daylight Time		06/03/2022 03:05:29 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	3	1						05/29/2022	2023.01	05/29/2022 09:11:35 AM Central Daylight Time		07/25/2022 09:01:24 AM Central Daylight Time			07/26/2022 11:30:45 AM 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:11:23 AM Central Daylight Time		06/03/2022 03:06:16 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:11:14 AM Central Daylight Time		06/03/2022 03:06:39 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:11:05 AM Central Daylight Time		06/03/2022 03:07:03 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:10:55 AM Central Daylight Time		06/03/2022 03:07:26 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:10:47 AM Central Daylight Time		06/03/2022 03:07:50 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:10:36 AM Central Daylight Time		06/03/2022 03:08:13 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:10:27 AM Central Daylight Time		06/03/2022 03:08:36 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:10:21 AM Central Daylight Time		06/03/2022 03:09:00 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:10:12 AM Central Daylight Time		06/03/2022 03:09:24 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:10:03 AM Central Daylight Time		06/03/2022 03:09:47 PM Central Daylight Time			06/04/2022 09:12:52 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	2023	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	2	1						05/29/2022	2023.01	05/29/2022 09:09:55 AM Central Daylight Time		06/03/2022 03:10:11 PM Central Daylight Time			06/04/2022 09:25:49 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	2023	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						05/29/2022	2023.01	05/29/2022 09:09:45 AM Central Daylight Time		07/15/2022 10:16:46 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	382	0	2023	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						05/29/2022	2023.01	05/29/2022 09:09:33 AM Central Daylight Time		07/15/2022 10:17:09 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	383	0	2023	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						05/29/2022	2023.01	05/29/2022 09:09:22 AM Central Daylight Time		07/15/2022 10:17:32 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	384	0	2023	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						05/29/2022	2023.01	05/29/2022 09:09:11 AM Central Daylight Time		07/15/2022 10:17:55 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	385	0	2023	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						05/29/2022	2023.01	05/29/2022 09:09:01 AM Central Daylight Time		07/15/2022 10:18:18 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	386	0	2023	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						05/29/2022	2023.01	05/29/2022 09:08:52 AM Central Daylight Time		07/15/2022 10:18:41 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	387	0	2023	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						05/29/2022	2023.01	05/29/2022 09:08:44 AM Central Daylight Time		07/15/2022 10:19:05 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	388	0	2023	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						05/29/2022	2023.01	05/29/2022 09:08:35 AM Central Daylight Time		07/15/2022 10:19:28 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	389	0	2023	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	5	1						05/29/2022	2023.01	05/29/2022 09:06:47 AM Central Daylight Time		07/15/2022 10:19:51 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	390	0	2023	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						05/29/2022	2023.01	05/29/2022 09:06:38 AM Central Daylight Time		07/15/2022 10:20:14 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	391	0	2023	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						05/29/2022	2023.01	05/29/2022 09:06:28 AM Central Daylight Time		07/15/2022 10:20:37 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	392	0	2023	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						05/29/2022	2023.01	05/29/2022 09:06:18 AM Central Daylight Time		07/15/2022 10:21:00 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	393	0	2023	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						05/29/2022	2023.01	05/29/2022 09:06:10 AM Central Daylight Time		07/15/2022 10:21:23 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	394	0	2023	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						05/29/2022	2023.01	05/29/2022 09:06:01 AM Central Daylight Time		07/15/2022 10:21:46 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	395	0	2023	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						05/29/2022	2023.01	05/29/2022 09:05:52 AM Central Daylight Time		07/15/2022 10:22:09 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	396	0	2023	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						05/29/2022	2023.01	05/29/2022 09:57:29 AM Central Daylight Time		07/15/2022 10:22:32 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	397	0	2023	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						05/29/2022	2023.01	05/29/2022 09:05:28 AM Central Daylight Time		07/15/2022 10:22:54 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	398	0	2023	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						05/29/2022	2023.01	05/29/2022 09:05:19 AM Central Daylight Time		07/15/2022 10:23:18 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	399	0	2023	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						05/29/2022	2023.01	05/29/2022 09:05:10 AM Central Daylight Time		07/15/2022 10:23:41 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	400	0	2023	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						05/29/2022	2023.01	05/29/2022 09:04:59 AM Central Daylight Time		07/15/2022 10:24:04 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	401	0	2023	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						05/29/2022	2023.01	05/29/2022 09:04:50 AM Central Daylight Time		07/15/2022 10:24:27 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	402	0	2023	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						05/29/2022	2023.01	05/29/2022 09:04:41 AM Central Daylight Time		07/15/2022 10:24:49 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	403	0	2023	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						05/29/2022	2023.01	05/29/2022 09:04:28 AM Central Daylight Time		07/15/2022 10:25:13 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	404	0	2023	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						05/29/2022	2023.01	05/29/2022 09:04:18 AM Central Daylight Time		07/15/2022 10:25:35 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	405	0	2023	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						05/29/2022	2023.01	05/29/2022 09:04:09 AM Central Daylight Time		07/15/2022 10:25:58 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	406	0	2023	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	3	1						05/29/2022	2023.01	05/29/2022 09:03:59 AM Central Daylight Time		07/15/2022 10:26:21 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	407	0	2023	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						05/29/2022	2023.01	05/29/2022 09:03:50 AM Central Daylight Time		07/15/2022 10:26:44 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	408	0	2023	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						05/29/2022	2023.01	05/29/2022 09:03:37 AM Central Daylight Time		07/15/2022 10:27:07 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	409	0	2023	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						05/29/2022	2023.01	05/29/2022 09:03:28 AM Central Daylight Time		07/15/2022 10:27:30 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	410	0	2023	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						05/29/2022	2023.01	05/29/2022 09:03:19 AM Central Daylight Time		07/15/2022 10:27:53 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	411	0	2023	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						05/29/2022	2023.01	05/29/2022 12:25:16 PM Central Daylight Time		07/15/2022 10:28:15 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	412	0	2023	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						05/29/2022	2023.01	05/29/2022 12:42:41 PM Central Daylight Time		07/15/2022 10:28:38 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	413	0	2023	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						05/29/2022	2023.01	05/29/2022 09:02:14 AM Central Daylight Time		07/15/2022 10:29:01 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	414	0	2023	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						05/29/2022	2023.01	05/29/2022 09:02:04 AM Central Daylight Time		07/15/2022 10:29:23 AM Central Daylight Time			07/19/2022 12:48:34 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	415	0	2023	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						06/03/2022	2023.01	06/03/2022 11:11:07 AM Eastern Daylight Time					06/03/2022 03:29:52 PM 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	2023	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						06/03/2022	2023.01	06/03/2022 11:11:12 AM Eastern Daylight Time					06/03/2022 03:29:52 PM 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	2023	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	3	1						06/03/2022	2023.01	06/03/2022 01:58:33 PM Eastern Daylight Time		06/04/2022 05:08:55 PM Eastern Daylight Time			06/06/2022 08:33:45 AM 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	2023	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						05/31/2022	2023.01	05/31/2022 03:05:32 PM Eastern Daylight Time		06/06/2022 11:32:08 AM Eastern Daylight Time			06/06/2022 12:09:37 PM 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	2023	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	2	1						05/31/2022	2023.01	05/31/2022 04:05:50 PM Eastern Daylight Time		06/04/2022 05:10:11 PM Eastern Daylight Time			06/06/2022 08:33:45 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	2023	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	1	1						04/22/2022	2023.01	04/22/2022 11:21:20 AM Eastern Daylight Time					06/02/2022 10:21:53 AM 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	2023	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	1	1						04/22/2022	2023.01	04/22/2022 11:22:26 AM Eastern Daylight Time					06/02/2022 10:21:53 AM 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	2023	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	2	1						04/21/2022	2023.01	04/21/2022 10:12:11 AM Eastern Daylight Time					06/02/2022 02:24:39 PM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	shop.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	803	0	2023	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	2	1						04/21/2022	2023.01	04/21/2022 10:12:14 AM Eastern Daylight Time					06/02/2022 02:24:39 PM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	shop.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	804	0	2023	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	2	1						04/21/2022	2023.01	04/21/2022 10:12:18 AM Eastern Daylight Time					06/02/2022 02:24:39 PM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	shop.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	805	0	2023	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	8	1						06/01/2022	2023.01	06/01/2022 09:36:01 AM Eastern Daylight Time					06/06/2022 05:17:28 PM Eastern Daylight Time	EMBLEMHEALTH PLAN, INC	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	803	0	2023	New York		1					2									www.emblemhealth.com	www.emblemhealth.com										(800)585-5786		(800)585-5786		(800)447-2254		(800)447-2254										(711)-		(711)-		(711)-		(711)-																
S5966	804	0		29	10	S5966_804_0	8	1						06/01/2022	2023.01	06/01/2022 09:36:07 AM Eastern Daylight Time					06/06/2022 05:17:28 PM Eastern Daylight Time	EMBLEMHEALTH PLAN, INC	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	804	0	2023	New York		1					2									www.emblemhealth.com	www.emblemhealth.com										(800)585-5786		(800)585-5786		(800)447-2254		(800)447-2254										(711)-		(711)-		(711)-		(711)-																
S5975	801	0		29	10	S5975_801_0	3	1						04/15/2022	2023.01	04/15/2022 01:33:39 PM Pacific Daylight Time					06/03/2022 12:35:26 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Group Rx (PDP)	10	29					S5975	801	0	2023	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	3	1						04/21/2022	2023.01	04/21/2022 01:15:57 PM Pacific Daylight Time					06/03/2022 12:35:26 PM 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	2023	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)-																
S5975	808	0		29	10	S5975_808_0	3	1						05/20/2022	2023.01	05/20/2022 02:11:02 PM Pacific Daylight Time					06/03/2022 12:35:26 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda National Group Rx (PDP)	10	29					S5975	808	0	2023	Nationwide		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	4	1						05/20/2022	2023.01	05/20/2022 01:28:39 PM Eastern Daylight Time		06/03/2022 08:34:03 AM Eastern Daylight Time			06/03/2022 08:38:19 AM 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	2023	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	4	1						05/25/2022	2023.01	05/25/2022 09:16:42 AM Eastern Daylight Time		06/03/2022 08:33:25 AM Eastern Daylight Time			06/03/2022 08:38:19 AM 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	2023	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	5	1						06/28/2022	2023.01	06/28/2022 07:06:52 AM Eastern Daylight Time		07/19/2022 07:55:07 AM Eastern Daylight Time			07/19/2022 10:23:14 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	2023	New Jersey		2					2									http://www.horizonblue.com/pdp-pharmacy-search	http://www.horizonblue.com/pdp-drug-search										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	801	0		29	10	S5993_801_0	1	1						05/17/2022	2023.01	05/17/2022 01:52:49 PM Eastern Daylight Time					05/25/2022 08:59:16 AM 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	2023	National		1					2									https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en/find-medicine.html										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	804	0		29	10	S5993_804_0	1	1						05/24/2022	2023.01	05/24/2022 02:03:55 PM Eastern Daylight Time					05/25/2022 08:59:16 AM 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	2023	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	1	1						05/24/2022	2023.01	05/24/2022 01:58:26 PM Eastern Daylight Time					05/25/2022 08:59:16 AM 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	2023	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	1	1						05/24/2022	2023.01	05/24/2022 02:01:08 PM Eastern Daylight Time					05/25/2022 08:59:16 AM 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	2023	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	3	1						05/31/2022	2023.01	05/31/2022 01:29:48 PM US Mountain Standard Time		06/01/2022 05:18:09 PM US Mountain Standard Time			06/03/2022 09:10:38 AM 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	2023	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	3	1						05/31/2022	2023.01	05/31/2022 01:14:27 PM US Mountain Standard Time		06/01/2022 05:18:14 PM US Mountain Standard Time			06/03/2022 09:10:38 AM 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	2023	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	3	1						05/31/2022	2023.01	05/31/2022 01:32:01 PM US Mountain Standard Time					06/03/2022 09:10:38 AM 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	2023	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						06/02/2022	2023.01	06/02/2022 03:48:06 PM Eastern Daylight Time					06/03/2022 09:25:36 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	2023	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						05/18/2022	2023.01	05/18/2022 04:34:18 PM Eastern Daylight Time					06/03/2022 09:25:36 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	2023	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	6	1						07/12/2022	2023.01	07/12/2022 08:25:28 AM Central Daylight Time		07/24/2022 08:23:21 PM Central Daylight Time			07/25/2022 05:28:50 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	2023	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	5	1						07/12/2022	2023.01	07/12/2022 08:26:46 AM Central Daylight Time		07/25/2022 01:35:32 PM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 10:43:43 AM Central Daylight Time		07/25/2022 08:59:08 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 10:47:33 AM Central Daylight Time		07/25/2022 09:09:17 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 10:50:52 AM Central Daylight Time		07/25/2022 09:13:57 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 10:54:10 AM Central Daylight Time		07/25/2022 09:16:15 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 02:05:55 PM Central Daylight Time		07/25/2022 09:17:52 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:01:09 AM Central Daylight Time		07/25/2022 09:22:13 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:04:30 AM Central Daylight Time		07/25/2022 09:25:48 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:07:05 AM Central Daylight Time		07/25/2022 09:26:46 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:09:23 AM Central Daylight Time		07/25/2022 09:34:24 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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	5	1						06/03/2022	2023.01	06/03/2022 11:11:36 AM Central Daylight Time		07/25/2022 09:35:50 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:14:27 AM Central Daylight Time		07/25/2022 09:37:40 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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	5	1						07/12/2022	2023.01	07/12/2022 08:28:08 AM Central Daylight Time		07/25/2022 09:38:33 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:20:47 AM Central Daylight Time		07/25/2022 09:40:02 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:24:35 AM Central Daylight Time		07/25/2022 09:41:33 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:26:53 AM Central Daylight Time		07/25/2022 09:42:29 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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	6	1						07/12/2022	2023.01	07/12/2022 08:29:46 AM Central Daylight Time		07/25/2022 09:43:35 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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	6	1						07/12/2022	2023.01	07/12/2022 08:31:17 AM Central Daylight Time		07/25/2022 09:44:41 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:34:51 AM Central Daylight Time		07/25/2022 09:45:43 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:37:28 AM Central Daylight Time		07/25/2022 09:46:39 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:40:06 AM Central Daylight Time		07/25/2022 09:47:37 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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	5	1						07/12/2022	2023.01	07/12/2022 08:33:06 AM Central Daylight Time		07/25/2022 09:49:21 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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	6	1						07/12/2022	2023.01	07/12/2022 08:34:38 AM Central Daylight Time		07/25/2022 09:50:28 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:45:32 AM Central Daylight Time		07/25/2022 09:51:22 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:47:24 AM Central Daylight Time		07/25/2022 09:52:42 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:49:15 AM Central Daylight Time		07/25/2022 09:53:36 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:50:17 AM Central Daylight Time		07/25/2022 09:54:55 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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						06/03/2022	2023.01	06/03/2022 11:52:28 AM Central Daylight Time		07/25/2022 09:55:59 AM Central Daylight Time			07/25/2022 05:28:50 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	2023	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	4	1					1	06/03/2022	2023.01	06/03/2022 12:43:44 PM Central Daylight Time		06/05/2022 06:48:50 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 12:46:51 PM Central Daylight Time		06/05/2022 06:49:58 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 12:48:36 PM Central Daylight Time		06/05/2022 06:52:36 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 12:50:53 PM Central Daylight Time		06/05/2022 06:53:42 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 12:52:45 PM Central Daylight Time		06/05/2022 06:54:30 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 02:52:30 PM Central Daylight Time		06/05/2022 06:55:40 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:04:05 PM Central Daylight Time		06/05/2022 06:57:12 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:05:38 PM Central Daylight Time		06/05/2022 06:58:30 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:07:58 PM Central Daylight Time		06/05/2022 07:00:04 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:10:01 PM Central Daylight Time		06/05/2022 07:01:46 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:12:05 PM Central Daylight Time		06/05/2022 07:02:54 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:16:20 PM Central Daylight Time		06/05/2022 07:06:38 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:19:12 PM Central Daylight Time		06/05/2022 07:07:54 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:25:03 PM Central Daylight Time		06/05/2022 07:09:08 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:26:59 PM Central Daylight Time		06/05/2022 07:10:28 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:28:49 PM Central Daylight Time		06/05/2022 07:11:14 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:31:25 PM Central Daylight Time		06/05/2022 07:12:20 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:34:05 PM Central Daylight Time		06/05/2022 07:13:08 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:37:47 PM Central Daylight Time		06/05/2022 07:13:54 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:39:41 PM Central Daylight Time		06/09/2022 02:33:36 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:41:21 PM Central Daylight Time		06/05/2022 07:17:08 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:44:31 PM Central Daylight Time		06/05/2022 07:18:16 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:46:15 PM Central Daylight Time		06/05/2022 07:19:22 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:48:15 PM Central Daylight Time		06/05/2022 07:20:14 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:50:26 PM Central Daylight Time		06/05/2022 07:21:10 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:52:33 PM Central Daylight Time		06/05/2022 07:22:02 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	3	1					1	06/03/2022	2023.01	06/03/2022 01:54:55 PM Central Daylight Time		06/05/2022 07:23:12 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	058	0		29	10	S6946_058_0	3	1					1	06/03/2022	2023.01	06/03/2022 01:57:04 PM Central Daylight Time		06/05/2022 07:24:52 PM Central Daylight Time			06/09/2022 04:34:50 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	2023	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	059	0		29	10	S6946_059_0	5	1					0	07/12/2022	2023.01	07/12/2022 08:35:56 AM Central Daylight Time		07/25/2022 09:57:01 AM Central Daylight Time			07/25/2022 05:28:50 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	059	0	2023	Northern New England		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	060	0		29	10	S6946_060_0	5	1					0	07/12/2022	2023.01	07/12/2022 08:37:32 AM Central Daylight Time		07/25/2022 09:58:05 AM Central Daylight Time			07/25/2022 05:28:50 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	060	0	2023	Central New England		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	061	0		29	10	S6946_061_0	5	1					0	07/12/2022	2023.01	07/12/2022 08:39:07 AM Central Daylight Time		07/25/2022 09:59:23 AM Central Daylight Time			07/25/2022 05:28:50 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	061	0	2023	New Mexico		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	062	0		29	10	S6946_062_0	5	1					0	07/12/2022	2023.01	07/12/2022 08:40:52 AM Central Daylight Time		07/25/2022 10:00:31 AM Central Daylight Time			07/25/2022 05:28:50 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	062	0	2023	Colorado		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	063	0		29	10	S6946_063_0	3	1					1	06/03/2022	2023.01	06/03/2022 01:58:58 PM Central Daylight Time		06/05/2022 07:26:54 PM Central Daylight Time			06/09/2022 04:34:50 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	063	0	2023	Northern New England		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	064	0		29	10	S6946_064_0	3	1					1	06/03/2022	2023.01	06/03/2022 02:00:54 PM Central Daylight Time		06/05/2022 07:28:06 PM Central Daylight Time			06/09/2022 04:34:50 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	064	0	2023	Central New England		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	065	0		29	10	S6946_065_0	3	1					1	06/03/2022	2023.01	06/03/2022 02:02:40 PM Central Daylight Time		06/05/2022 07:29:34 PM Central Daylight Time			06/09/2022 04:34:50 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	065	0	2023	New Mexico		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	066	0		29	10	S6946_066_0	3	1					1	06/03/2022	2023.01	06/03/2022 02:04:19 PM Central Daylight Time		06/05/2022 07:31:28 PM Central Daylight Time			06/09/2022 04:34:50 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	066	0	2023	Colorado		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	6	1					0	05/31/2022	2023.01	05/31/2022 06:56:08 AM Central Daylight Time		07/20/2022 12:37:32 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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	2	1					0	05/31/2022	2023.01	05/31/2022 06:57:41 AM Central Daylight Time		07/20/2022 12:37:35 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	003	0		29	10	S7126_003_0	2	1					0	05/31/2022	2023.01	05/31/2022 06:59:02 AM Central Daylight Time		07/20/2022 12:33:54 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	004	0		29	10	S7126_004_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:00:14 AM Central Daylight Time		07/20/2022 12:33:58 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	005	0		29	10	S7126_005_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:01:24 AM Central Daylight Time		07/20/2022 12:34:01 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	006	0		29	10	S7126_006_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:02:50 AM Central Daylight Time		07/20/2022 12:34:05 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	007	0		29	10	S7126_007_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:35:37 AM Central Daylight Time		07/20/2022 12:34:08 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	008	0		29	10	S7126_008_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:34:37 AM Central Daylight Time		07/20/2022 12:34:13 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	009	0		29	10	S7126_009_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:33:15 AM Central Daylight Time		07/20/2022 12:34:16 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	010	0		29	10	S7126_010_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:32:20 AM Central Daylight Time		07/20/2022 12:34:20 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	011	0		29	10	S7126_011_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:31:25 AM Central Daylight Time		07/20/2022 12:34:22 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	012	0		29	10	S7126_012_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:30:15 AM Central Daylight Time		07/20/2022 12:34:25 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	013	0		29	10	S7126_013_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:27:59 AM Central Daylight Time		07/20/2022 12:34:27 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	014	0		29	10	S7126_014_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:26:58 AM Central Daylight Time		07/20/2022 12:34:31 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	015	0		29	10	S7126_015_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:26:01 AM Central Daylight Time		07/20/2022 12:34:35 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	016	0		29	10	S7126_016_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:24:56 AM Central Daylight Time		07/20/2022 12:34:38 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	017	0		29	10	S7126_017_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:23:57 AM Central Daylight Time		07/20/2022 12:34:41 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	018	0		29	10	S7126_018_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:20:22 AM Central Daylight Time		07/20/2022 12:34:44 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	019	0		29	10	S7126_019_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:19:20 AM Central Daylight Time		07/20/2022 12:34:47 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	020	0		29	10	S7126_020_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:18:11 AM Central Daylight Time		07/20/2022 12:34:50 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	021	0		29	10	S7126_021_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:17:15 AM Central Daylight Time		07/20/2022 12:34:53 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	022	0		29	10	S7126_022_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:16:04 AM Central Daylight Time		07/20/2022 12:34:56 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	023	0		29	10	S7126_023_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:14:51 AM Central Daylight Time		07/20/2022 12:35:00 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	024	0		29	10	S7126_024_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:13:52 AM Central Daylight Time		07/20/2022 12:35:03 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	025	0		29	10	S7126_025_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:12:48 AM Central Daylight Time		07/20/2022 12:35:06 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	026	0		29	10	S7126_026_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:11:40 AM Central Daylight Time		07/20/2022 12:35:10 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	027	0		29	10	S7126_027_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:10:39 AM Central Daylight Time		07/20/2022 12:35:13 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	028	0		29	10	S7126_028_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:09:34 AM Central Daylight Time		07/20/2022 12:35:16 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	029	0		29	10	S7126_029_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:08:24 AM Central Daylight Time		07/20/2022 12:35:20 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	030	0		29	10	S7126_030_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:07:15 AM Central Daylight Time		07/20/2022 12:35:24 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	031	0		29	10	S7126_031_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:06:12 AM Central Daylight Time		07/20/2022 12:35:26 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	032	0		29	10	S7126_032_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:05:06 AM Central Daylight Time		07/20/2022 12:35:30 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	033	0		29	10	S7126_033_0	2	1					0	05/31/2022	2023.01	05/31/2022 07:04:03 AM Central Daylight Time		07/20/2022 12:35:34 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	071	0		29	10	S7126_071_0	3	1					1	05/31/2022	2023.01	05/31/2022 08:17:29 AM Central Daylight Time		07/20/2022 12:35:37 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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	072	0		29	10	S7126_072_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:17:11 AM Central Daylight Time		07/20/2022 12:35:41 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	073	0		29	10	S7126_073_0	2	1					1	06/01/2022	2023.01	06/01/2022 05:14:44 PM Central Daylight Time		07/20/2022 12:35:45 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	074	0		29	10	S7126_074_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:16:33 AM Central Daylight Time		07/20/2022 12:35:48 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	075	0		29	10	S7126_075_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:16:13 AM Central Daylight Time		07/20/2022 12:35:55 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	076	0		29	10	S7126_076_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:15:56 AM Central Daylight Time		07/20/2022 12:35:59 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	077	0		29	10	S7126_077_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:15:27 AM Central Daylight Time		07/20/2022 12:36:03 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	078	0		29	10	S7126_078_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:15:06 AM Central Daylight Time		07/20/2022 12:36:05 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	079	0		29	10	S7126_079_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:14:41 AM Central Daylight Time		07/20/2022 12:36:11 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	080	0		29	10	S7126_080_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:14:17 AM Central Daylight Time		07/20/2022 12:36:16 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	081	0		29	10	S7126_081_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:13:56 AM Central Daylight Time		07/20/2022 12:36:18 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	082	0		29	10	S7126_082_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:13:36 AM Central Daylight Time		07/20/2022 12:36:22 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	083	0		29	10	S7126_083_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:13:14 AM Central Daylight Time		07/20/2022 12:36:25 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	084	0		29	10	S7126_084_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:12:53 AM Central Daylight Time		07/20/2022 12:36:29 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	085	0		29	10	S7126_085_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:12:30 AM Central Daylight Time		07/20/2022 12:36:32 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	086	0		29	10	S7126_086_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:12:08 AM Central Daylight Time		07/20/2022 12:36:35 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	087	0		29	10	S7126_087_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:11:49 AM Central Daylight Time		07/20/2022 12:36:37 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	088	0		29	10	S7126_088_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:11:30 AM Central Daylight Time		07/20/2022 12:36:39 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	089	0		29	10	S7126_089_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:10:38 AM Central Daylight Time		07/20/2022 12:36:42 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	090	0		29	10	S7126_090_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:10:06 AM Central Daylight Time		07/20/2022 12:36:46 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	091	0		29	10	S7126_091_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:09:43 AM Central Daylight Time		07/20/2022 12:36:48 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	092	0		29	10	S7126_092_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:09:23 AM Central Daylight Time		07/20/2022 12:36:51 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	093	0		29	10	S7126_093_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:09:05 AM Central Daylight Time		07/20/2022 12:36:55 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	094	0		29	10	S7126_094_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:08:44 AM Central Daylight Time		07/20/2022 12:36:57 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	095	0		29	10	S7126_095_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:08:25 AM Central Daylight Time		07/20/2022 12:37:00 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	096	0		29	10	S7126_096_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:08:00 AM Central Daylight Time		07/20/2022 12:37:04 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	097	0		29	10	S7126_097_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:07:42 AM Central Daylight Time		07/20/2022 12:37:08 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	098	0		29	10	S7126_098_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:07:21 AM Central Daylight Time		07/20/2022 12:37:11 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	099	0		29	10	S7126_099_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:06:48 AM Central Daylight Time		07/20/2022 12:37:14 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	100	0		29	10	S7126_100_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:06:23 AM Central Daylight Time		07/20/2022 12:37:16 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	101	0		29	10	S7126_101_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:05:53 AM Central Daylight Time		07/20/2022 12:37:20 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	102	0		29	10	S7126_102_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:05:24 AM Central Daylight Time		07/20/2022 12:37:24 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	103	0		29	10	S7126_103_0	2	1					1	05/31/2022	2023.01	05/31/2022 08:04:02 AM Central Daylight Time		07/20/2022 12:37:28 PM Central Daylight Time			07/20/2022 12:44:17 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	2023	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		(711)-		(711)-																
S7126	104	0		29	10	S7126_104_0	2	1					0	05/31/2022	2023.01	05/31/2022 08:03:08 AM Central Daylight Time		06/03/2022 07:51:22 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	104	0	2023	Northern New England		2					2									www.mutualofomaha.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	105	0		29	10	S7126_105_0	1	1					0	05/31/2022	2023.01	05/31/2022 08:02:50 AM Central Daylight Time		06/03/2022 07:50:13 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	105	0	2023	Central New England		2					2									www.mutualofomaha.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	106	0		29	10	S7126_106_0	1	1					0	05/31/2022	2023.01	05/31/2022 08:02:26 AM Central Daylight Time		06/03/2022 07:50:15 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	106	0	2023	State of New Jersey		2					2									www.mutualofomaha.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	107	0		29	10	S7126_107_0	1	1					0	05/31/2022	2023.01	05/31/2022 08:02:03 AM Central Daylight Time		06/03/2022 07:50:17 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	107	0	2023	Mid-Atlantic		2					2									www.mutualofomaha.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	108	0		29	10	S7126_108_0	1	1					0	05/31/2022	2023.01	05/31/2022 08:01:39 AM Central Daylight Time		06/03/2022 07:50:18 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	108	0	2023	States of Pennsylvania and West Virginia		2					2									www.mutualofomaha.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	109	0		29	10	S7126_109_0	1	1					0	05/31/2022	2023.01	05/31/2022 08:01:13 AM Central Daylight Time		06/03/2022 07:50:20 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	109	0	2023	State of Virginia		2					2									www.mutualofomaha.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	110	0		29	10	S7126_110_0	1	1					0	05/31/2022	2023.01	05/31/2022 08:00:43 AM Central Daylight Time		06/03/2022 07:50:22 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	110	0	2023	State of North Carolina		2					2									www.mutualofomaha.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	111	0		29	10	S7126_111_0	1	1					0	05/31/2022	2023.01	05/31/2022 08:00:19 AM Central Daylight Time		06/03/2022 07:50:24 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	111	0	2023	State of South Carolina		2					2									www.mutualofomaha.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	112	0		29	10	S7126_112_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:59:53 AM Central Daylight Time		06/03/2022 07:50:26 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	112	0	2023	State of Georgia		2					2									www.mutualofomaha.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	113	0		29	10	S7126_113_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:59:30 AM Central Daylight Time		06/03/2022 07:50:27 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	113	0	2023	State of Florida		2					2									www.mutualofomaha.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	114	0		29	10	S7126_114_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:58:58 AM Central Daylight Time		06/03/2022 07:50:29 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	114	0	2023	States of Alabama and Tennessee		2					2									www.mutualofomaha.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	115	0		29	10	S7126_115_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:58:38 AM Central Daylight Time		06/03/2022 07:50:32 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	115	0	2023	State of Michigan		2					2									www.mutualofomaha.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	116	0		29	10	S7126_116_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:58:18 AM Central Daylight Time		06/03/2022 07:50:33 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	116	0	2023	State of Ohio		2					2									www.mutualofomaha.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	117	0		29	10	S7126_117_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:57:46 AM Central Daylight Time		06/03/2022 07:50:35 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	117	0	2023	States of Indiana and Kentucky		2					2									www.mutualofomaha.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	118	0		29	10	S7126_118_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:57:14 AM Central Daylight Time		06/03/2022 07:50:37 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	118	0	2023	State of Wisconsin		2					2									www.mutualofomaha.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	119	0		29	10	S7126_119_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:56:46 AM Central Daylight Time		06/03/2022 07:50:39 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	119	0	2023	State of Illinois		2					2									www.mutualofomaha.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	120	0		29	10	S7126_120_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:56:01 AM Central Daylight Time		06/03/2022 07:50:40 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	120	0	2023	State of Missouri		2					2									www.mutualofomaha.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	121	0		29	10	S7126_121_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:55:39 AM Central Daylight Time		06/03/2022 07:50:42 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	121	0	2023	State of Arkansas		2					2									www.mutualofomaha.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	122	0		29	10	S7126_122_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:55:15 AM Central Daylight Time		06/03/2022 07:50:44 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	122	0	2023	State of Missippi		2					2									www.mutualofomaha.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	123	0		29	10	S7126_123_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:51:33 AM Central Daylight Time		06/03/2022 07:50:46 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	123	0	2023	State of Louisiana		2					2									www.mutualofomaha.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	124	0		29	10	S7126_124_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:51:00 AM Central Daylight Time		06/03/2022 07:50:48 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	124	0	2023	State of Texas		2					2									www.mutualofomaha.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	125	0		29	10	S7126_125_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:50:35 AM Central Daylight Time		06/03/2022 07:50:49 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	125	0	2023	State of Oklahoma		2					2									www.mutualofomaha.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	126	0		29	10	S7126_126_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:50:11 AM Central Daylight Time		06/03/2022 07:50:52 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	126	0	2023	State of Kansas		2					2									www.mutualofomaha.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	127	0		29	10	S7126_127_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:49:45 AM Central Daylight Time		06/03/2022 07:50:53 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	127	0	2023	Upper Midwest and Northern Plains		2					2									www.mutualofomaha.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	128	0		29	10	S7126_128_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:49:17 AM Central Daylight Time		06/03/2022 07:50:55 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	128	0	2023	State of New Mexico		2					2									www.mutualofomaha.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	129	0		29	10	S7126_129_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:47:55 AM Central Daylight Time		06/03/2022 07:50:57 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	129	0	2023	State of Colorado		2					2									www.mutualofomaha.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	130	0		29	10	S7126_130_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:48:17 AM Central Daylight Time		06/03/2022 07:50:59 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	130	0	2023	State of Arizona		2					2									www.mutualofomaha.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	131	0		29	10	S7126_131_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:46:39 AM Central Daylight Time		06/03/2022 07:51:00 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	131	0	2023	State of Nevada		2					2									www.mutualofomaha.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	132	0		29	10	S7126_132_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:46:12 AM Central Daylight Time		06/03/2022 07:51:03 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	132	0	2023	States of Oregon and Washington		2					2									www.mutualofomaha.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	133	0		29	10	S7126_133_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:45:48 AM Central Daylight Time		06/03/2022 07:51:04 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	133	0	2023	States of Idaho and Utah		2					2									www.mutualofomaha.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	134	0		29	10	S7126_134_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:45:25 AM Central Daylight Time		06/03/2022 07:51:06 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	134	0	2023	State of California		2					2									www.mutualofomaha.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	135	0		29	10	S7126_135_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:44:59 AM Central Daylight Time		06/03/2022 07:51:08 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	135	0	2023	State of Hawaii		2					2									www.mutualofomaha.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	136	0		29	10	S7126_136_0	1	1					0	05/31/2022	2023.01	05/31/2022 07:44:26 AM Central Daylight Time		06/03/2022 07:51:10 AM Central Daylight Time			06/03/2022 08:05:29 AM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Essential (PDP)	10	29					S7126	136	0	2023	State of Alaska		2					2									www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(711)-		(711)-																
S7694	001	0		29	10	S7694_001_0	7	1						06/06/2022	2023.01	06/06/2022 10:19:44 AM Pacific Daylight Time		06/03/2022 05:10:22 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	001	0	2023	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	6	1						06/02/2022	2023.01	06/02/2022 03:31:43 PM Pacific Daylight Time		06/03/2022 05:10:56 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	002	0	2023	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	6	1						06/02/2022	2023.01	06/02/2022 09:51:39 PM Pacific Daylight Time		06/03/2022 05:11:30 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	003	0	2023	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	6	1						06/02/2022	2023.01	06/02/2022 09:58:59 PM Pacific Daylight Time		06/03/2022 05:12:06 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	004	0	2023	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	6	1						06/02/2022	2023.01	06/02/2022 10:07:24 PM Pacific Daylight Time		06/03/2022 05:12:40 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	005	0	2023	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	6	1						06/02/2022	2023.01	06/02/2022 10:12:56 PM Pacific Daylight Time		06/03/2022 05:13:16 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	006	0	2023	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	6	1						06/02/2022	2023.01	06/02/2022 10:17:56 PM Pacific Daylight Time		06/03/2022 05:13:50 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	007	0	2023	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	6	1						06/02/2022	2023.01	06/02/2022 10:23:46 PM Pacific Daylight Time		06/03/2022 05:14:26 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	008	0	2023	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	6	1						06/02/2022	2023.01	06/02/2022 10:38:18 PM Pacific Daylight Time		06/03/2022 05:15:00 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	009	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 03:04:43 PM Pacific Daylight Time		06/03/2022 05:15:36 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	010	0	2023	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	6	1						06/02/2022	2023.01	06/02/2022 10:51:49 PM Pacific Daylight Time		06/03/2022 05:16:10 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	011	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 03:09:14 PM Pacific Daylight Time		06/03/2022 05:16:44 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	012	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:28:36 AM Pacific Daylight Time		06/03/2022 05:17:18 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	014	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 10:58:13 AM Pacific Daylight Time		06/03/2022 05:17:54 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	015	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 10:04:00 AM Pacific Daylight Time		06/03/2022 05:18:30 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	016	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 10:23:02 AM Pacific Daylight Time		06/03/2022 05:18:56 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	017	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 03:12:50 PM Pacific Daylight Time		06/03/2022 05:20:14 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	018	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 11:00:55 AM Pacific Daylight Time		06/03/2022 05:20:48 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	019	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 11:05:25 AM Pacific Daylight Time		06/03/2022 05:21:20 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	020	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 11:17:19 AM Pacific Daylight Time		06/03/2022 05:21:54 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	021	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 11:24:07 AM Pacific Daylight Time		06/03/2022 05:22:28 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	022	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 11:29:06 AM Pacific Daylight Time		06/03/2022 05:23:02 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	023	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 11:38:41 AM Pacific Daylight Time		06/03/2022 05:23:34 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	024	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 11:49:28 AM Pacific Daylight Time		06/03/2022 05:24:12 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	025	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 11:55:25 AM Pacific Daylight Time		06/03/2022 05:24:46 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	026	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:02:07 PM Pacific Daylight Time		06/03/2022 05:25:20 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	027	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:10:18 PM Pacific Daylight Time		06/03/2022 05:25:56 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	028	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:15:17 PM Pacific Daylight Time		06/03/2022 05:26:30 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	029	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:19:00 PM Pacific Daylight Time		06/03/2022 05:27:02 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	030	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:23:17 PM Pacific Daylight Time		06/03/2022 05:27:36 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	031	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:26:24 PM Pacific Daylight Time		06/03/2022 05:28:10 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	032	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:30:14 PM Pacific Daylight Time		06/03/2022 05:28:42 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	033	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:33:59 PM Pacific Daylight Time		06/03/2022 05:29:16 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	034	0	2023	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	6	1						06/03/2022	2023.01	06/03/2022 12:37:47 PM Pacific Daylight Time		06/03/2022 05:29:50 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	070	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:06:03 PM Pacific Daylight Time		06/03/2022 06:29:02 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	121	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:11:33 PM Pacific Daylight Time		06/03/2022 06:29:36 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	122	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:14:28 PM Pacific Daylight Time		06/03/2022 06:30:10 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	123	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:18:38 PM Pacific Daylight Time		06/03/2022 06:30:44 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	124	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:25:05 PM Pacific Daylight Time		06/03/2022 06:31:18 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	125	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:33:38 PM Pacific Daylight Time		06/03/2022 06:31:54 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	126	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:36:35 PM Pacific Daylight Time		06/03/2022 06:32:26 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	127	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:38:48 PM Pacific Daylight Time		06/03/2022 06:33:02 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	128	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:43:36 PM Pacific Daylight Time		06/03/2022 06:33:36 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	129	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:46:10 PM Pacific Daylight Time		06/03/2022 06:34:02 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	130	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 01:48:27 PM Pacific Daylight Time		06/03/2022 06:39:20 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	131	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 02:19:18 PM Pacific Daylight Time		06/03/2022 06:39:52 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	132	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 02:35:45 PM Pacific Daylight Time		06/03/2022 06:40:26 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	133	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 02:38:56 PM Pacific Daylight Time		06/03/2022 06:40:58 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	134	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 02:45:04 PM Pacific Daylight Time		06/03/2022 06:41:30 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	135	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 02:48:29 PM Pacific Daylight Time		06/03/2022 06:42:02 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	136	0	2023	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	5	1						06/03/2022	2023.01	06/03/2022 02:52:52 PM Pacific Daylight Time		06/03/2022 06:42:36 PM Pacific Daylight Time			06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	137	0	2023	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	4	1						05/31/2022	2023.01	05/31/2022 09:59:29 AM Pacific Daylight Time					06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://envisionrxplus.com	Employer Plan Calendar Year (PDP)	10	29					S7694	801	0	2023	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	4	1						06/01/2022	2023.01	06/01/2022 10:40:14 AM Pacific Daylight Time					06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://envisionrxplus.com	Employer Group Non-Calendar Year (PDP)	10	29					S7694	802	0	2023	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	4	1						06/01/2022	2023.01	06/01/2022 10:41:12 AM Pacific Daylight Time					06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare 4TC (PDP)	10	29					S7694	803	0	2023	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	4	1						06/01/2022	2023.01	06/01/2022 10:41:37 AM Pacific Daylight Time					06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare 5TC (PDP)	10	29					S7694	804	0	2023	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	4	1						06/01/2022	2023.01	06/01/2022 10:42:37 AM Pacific Daylight Time					06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare 4TO (PDP)	10	29					S7694	805	0	2023	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	4	1						06/01/2022	2023.01	06/01/2022 10:43:16 AM Pacific Daylight Time					06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare 5TO (PDP)	10	29					S7694	806	0	2023	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	4	1						06/01/2022	2023.01	06/01/2022 10:43:59 AM Pacific Daylight Time					06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare Bronze (PDP)	10	29					S7694	807	0	2023	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	4	1						06/06/2022	2023.01	06/06/2022 08:59:41 AM Pacific Daylight Time					06/06/2022 03:12:52 PM Pacific Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://envisionrxplus.com	Employer Group Broad (PDP)	10	29					S7694	808	0	2023	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						06/02/2022	2023.01	06/02/2022 03:50:03 PM Eastern Daylight Time		06/04/2022 10:13:22 PM Eastern Daylight Time			06/05/2022 09:04:19 AM Eastern Daylight Time	Avalon Insurance Company	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 3 (PDP)	10	29					S8067	001	0	2023	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	05/26/2022	2023.01	05/26/2022 01:36:37 PM Eastern Daylight Time		06/04/2022 10:14:24 PM Eastern Daylight Time			06/05/2022 09:04:19 AM Eastern Daylight Time	Avalon Insurance Company	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 1 (PDP)	10	29					S8067	003	0	2023	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						05/12/2022	2023.01	05/12/2022 03:38:23 PM Eastern Daylight Time					06/04/2022 04:46:24 PM Eastern Daylight Time	Avalon Insurance Company	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Rx (CY) (PDP)	10	29					S8067	801	0	2023	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						06/01/2022	2023.01	06/01/2022 05:26:01 PM Eastern Daylight Time					06/04/2022 04:46:24 PM Eastern Daylight Time	Avalon Insurance Company	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Custom Rx (CY) (PDP)	10	29					S8067	803	0	2023	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						06/01/2022	2023.01	06/01/2022 05:30:13 PM Eastern Daylight Time					06/04/2022 04:46:24 PM Eastern Daylight Time	Avalon Insurance Company	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Standard Rx (CY) (PDP)	10	29					S8067	804	0	2023	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						06/01/2022	2023.01	06/01/2022 05:31:13 PM Eastern Daylight Time					06/04/2022 04:46:24 PM Eastern Daylight Time	Avalon Insurance Company	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Complete Rx (CY) (PDP)	10	29					S8067	805	0	2023	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						06/01/2022	2023.01	06/01/2022 05:32:10 PM Eastern Daylight Time					06/04/2022 04:46:24 PM Eastern Daylight Time	Avalon Insurance Company	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Custom Rx (FY) (PDP)	10	29					S8067	806	0	2023	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						06/01/2022	2023.01	06/01/2022 05:33:52 PM Eastern Daylight Time					06/04/2022 04:46:24 PM Eastern Daylight Time	Avalon Insurance Company	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Standard Rx (FY) (PDP)	10	29					S8067	807	0	2023	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						06/01/2022	2023.01	06/01/2022 05:34:56 PM Eastern Daylight Time					06/04/2022 04:46:24 PM Eastern Daylight Time	Avalon Insurance Company	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Rx (FY) (PDP)	10	29					S8067	808	0	2023	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	3	1						06/06/2022	2023.01	06/06/2022 05:33:13 PM Eastern Daylight Time		07/11/2022 03:19:53 PM Eastern Daylight Time			07/15/2022 01:08:23 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Rx Basic (PDP)	10	29					S8182	001	0	2023	Texas		2					2									https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(833)377-4265		(833)377-4265		(855)793-1941		(855)793-1941										(711)-		(711)-		(711)-		(711)-																
S8182	003	0		29	10	S8182_003_0	4	1						06/06/2022	2023.01	06/06/2022 05:34:22 PM Eastern Daylight Time		07/18/2022 03:09:12 PM Eastern Daylight Time			07/19/2022 10:52:59 AM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Rx Basic (PDP)	10	29					S8182	003	0	2023	Arizona		2					2									https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(833)377-4265		(833)377-4265		(855)793-1941		(855)793-1941										(711)-		(711)-		(711)-		(711)-																
S8182	005	0		29	10	S8182_005_0	3	1					1	06/06/2022	2023.01	06/06/2022 05:35:36 PM Eastern Daylight Time		07/11/2022 03:22:20 PM Eastern Daylight Time			07/15/2022 01:08:23 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Rx Plus (PDP)	10	29					S8182	005	0	2023	Texas		2					2									https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(833)377-4265		(833)377-4265		(855)793-1941		(855)793-1941										(711)-		(711)-		(711)-		(711)-																
S8182	006	0		29	10	S8182_006_0	4	1					1	06/06/2022	2023.01	06/06/2022 05:37:14 PM Eastern Daylight Time		07/11/2022 03:23:35 PM Eastern Daylight Time			07/15/2022 01:08:23 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Rx Plus (PDP)	10	29					S8182	006	0	2023	Arizona		2					2									https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(833)377-4265		(833)377-4265		(855)793-1941		(855)793-1941										(711)-		(711)-		(711)-		(711)-																
S8841	803	0		29	10	S8841_803_0	2	1						06/01/2022	2023.01	06/01/2022 11:35:44 AM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Silver 2023 - CY (PDP)	10	29					S8841	803	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:15:07 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Silver 2023 - NCY (PDP)	10	29					S8841	804	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:15:32 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Bronze 2023 - CY (PDP)	10	29					S8841	807	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:16:00 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Bronze 2023 - NCY (PDP)	10	29					S8841	808	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:16:43 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	MPSERS 2023 (PDP)	10	29					S8841	810	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:17:07 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Gold 5-Tier 2023 - CY (PDP)	10	29					S8841	812	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:17:30 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Gold 5-Tier 2023 - NCY (PDP)	10	29					S8841	813	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:17:49 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE PDP 2023 - CY (PDP)	10	29					S8841	814	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:18:06 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE PDP 2023 - NCY (PDP)	10	29					S8841	815	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:18:44 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE PDP Basic 2023 (CY) (PDP)	10	29					S8841	818	0	2023	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	2	1						05/25/2022	2023.01	05/25/2022 12:19:35 PM US Mountain Standard Time					06/01/2022 11:36:25 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE PDP Basic 2023 (NCY) (PDP)	10	29					S8841	819	0	2023	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)-																
S9409	801	0		29	10	S9409_801_0	4	1						05/19/2022	2023.01	05/19/2022 04:35:12 PM Eastern Daylight Time					06/06/2022 07:13:11 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group PDP (PDP)	10	29					S9409	801	0	2023	Vermont		1					2									www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies										(855)489-0646		(855)489-0646		(855)489-0646		(855)489-0646										(711)-		(711)-		(711)-		(711)-																
S9701	801	0		29	10	S9701_801_0	1	1						06/02/2022	2023.01	06/02/2022 10:09:07 AM Central Daylight Time					06/02/2022 01:00:44 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	801	0	2023	Navitus MedicareRx		1					2									https://medicarerx.navitus.com/	https://medicarerx.navitus.com/										(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	802	0		29	10	S9701_802_0	1	1						06/02/2022	2023.01	06/02/2022 10:04:39 AM Central Daylight Time					06/02/2022 01:00:44 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	802	0	2023	Navitus MedicareRx		1					2									https://medicarerx.navitus.com/	https://medicarerx.navitus.com/										(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	803	0		29	10	S9701_803_0	1	1						06/02/2022	2023.01	06/02/2022 10:06:50 AM Central Daylight Time					06/02/2022 01:00:44 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	803	0	2023	Navitus MedicareRx		1					2									https://medicarerx.navitus.com/	https://medicarerx.navitus.com/										(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	804	0		29	10	S9701_804_0	1	1						06/02/2022	2023.01	06/02/2022 10:05:00 AM Central Daylight Time					06/02/2022 01:00:44 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	804	0	2023	Navitus MedicareRx		1					2									https://medicarerx.navitus.com/	https://medicarerx.navitus.com/										(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	807	0		29	10	S9701_807_0	1	1						06/02/2022	2023.01	06/02/2022 10:05:07 AM Central Daylight Time					06/02/2022 01:00:44 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	807	0	2023	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	1	1						06/02/2022	2023.01	06/02/2022 10:05:22 AM Central Daylight Time					06/02/2022 01:00:44 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	808	0	2023	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)-																
S9854	801	0		29	10	S9854_801_0	4	1						05/19/2022	2023.01	05/19/2022 04:34:43 PM Eastern Daylight Time					06/06/2022 07:13:11 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmarkadvantagehealthplan.com	Blue Medicare Advantage Group PDP (PDP)	10	29					S9854	801	0	2023	Iowa and South Dakota		1					2									www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare										(888)832-6168		(888)832-6168		(800)213-3771		(800)213-3771										(711)-		(711)-		(711)-		(711)-																
